Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001501 DEA: 040X7204 EFIS: 0424000160 COOP: 04JOC25101
QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-128-12.2/24.8
Work Description: DIGOUT
Location Description: CONSTRUCTION ON STATE HIGHWAY IN SONOMA COUNTY AT AND NEAR KELLOGG FROM SAUSAL CREEK BRIDGE TO NAPA COUNTY LINE.
Contractor Name: OC Jones
Contractor Address: Unknown
Resident Engineer: Leonard Brajnikoff Structure Rep.: Unknown
DIME Sample ID: 2025-08-27-96
TL Number from the TL Form: C100600
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: Hot Mix Asphalt
Sample Taken Date: 08/27/2025
Date that the sample was received by the laboratory/organization performing the testing: 09/16/2025
The quantity of what the sample constitutes: 20 Boxes HMA-A
A brief description of the sample: 3/4" HMA-A
From where was the sample collected: Manufacturer
Laboratory sample identification: D04-SE-25-061
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Materials Todd Road (BP)
