Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995174 DEA: 043W5604 EFIS: 0421000388
QA Service Level: 1
DIST-CO-RTE-PM: 04-SOL-12,80,680-Var
Work Description: POLYESTER CONCRETE OVERLAY.
Location Description: SOLANO COUNTY AT VARIOUS LOCATIONS
Contractor Name: MYERS & SONS CONSTRUCTION, LLC
Contractor Address: 45 Morrison ave, Sacramento, CA 95838
Resident Engineer: Justen Tatum Structure Rep.: Kambiz Kouchesfahani
DIME Sample ID: 2025-08-04-110
TL Number from the TL Form: CON-080425-1
Sample Submitted By Organization: CT D04 - Hayward DME / District Laboratory
Sample Organization Contact: (510) 507-3456
Type of Sample: Production Start-Up
Type of Material: Reclaimed Asphalt Pavement
Sample Taken Date: 08/04/2025
Date that the sample was received by the laboratory/organization performing the testing: 09/11/2025
The quantity of what the sample constitutes: 4 bags colfeed agg.
A brief description of the sample: 3/4"HMA-R25-WMA
From where was the sample collected: Manufacturer
Laboratory sample identification: D04-SE-25-057
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Materials LH (DP)
