Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212470 DEA: 044A1304 EFIS: 0400001106 COOP: 042718
QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-101-18.5/18.5
Work Description: CONSISTS OF MODIFICATION AND RECONSTRUCTION OF THE EXISTING US 101/HEARN AVENUE INTERCHANGE IN SONOMA COUNTY, INCLUDING REPLACING THE EXISTING TWO-LANE HEARN AVENUE OVERCROSSING WITH A NEW OVERCROSSING, AND MODIFYING THE SOUTHBOUND OFF-RAMP IN CITY
Location Description: IN SONOMA COUNTY.
Contractor Name: Ghilotti Construction Company, Inc. (Chase McPhaul)
Contractor Address: 246 Ghilotti Avenue, Santa Rosa, CA 95407
Resident Engineer: Seyed "Syd" Valeh Structure Rep.: Anthony "Tony" Tierra; Sardar Chalabe
DIME Sample ID: 2025-10-27-9
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3672 - Santa Rosa
Sample Organization Contact: (510) 774-6009
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 10/27/2025
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: MULTIPLE LANES
A brief description of the sample: Skid Test Request
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Ghilotti Construction
Pavement Surface Type: CRCP (Continuously Reinforced Concrete Pavement)
Type of Traffic Control Provided: Behind K-Rail/Barrier
DIST-CO-RTE: 04
Direction of Travel: North
Post Mile: 18.50
Lanes to be Tested: Lane #1
Station:
