Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000017 DEA: 042Q7004 EFIS: 0419000040
QA Service Level: 1
DIST-CO-RTE-PM: 04-CC-4-L0.0/R14.3
Work Description: REPLACE ASPHALT CONCRETE SURFACING AND INSTALL MGS.
Location Description: CONTRA COSTA COUNTY IN HERCULES AND CONCORD FROM SAN PABLO AVENUE TO ROUTE 4/242 SEPARATION
Contractor Name: BAY CITIES PAVING & GRADING, INC.
Contractor Address: Unknown
Resident Engineer: Rabindra Mukherjee Structure Rep.: John K. Parecadan
DIME Sample ID: 2025-08-01-83
TL Number from the TL Form: CON-080125-1
Sample Submitted By Organization: CT D04 - Hayward DME / District Laboratory
Sample Organization Contact: (510) 507-3456
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 08/01/2025
Date that the sample was received by the laboratory/organization performing the testing: 08/14/2025
The quantity of what the sample constitutes: 20 boxes of mix
A brief description of the sample: 1/2" RHMA-G-WMA
From where was the sample collected: Manufacturer
Laboratory sample identification: D04-SE-25-050
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Dutra Richmond
