Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994310 DEA: 034F6504 EFIS: 0314000233
QA Service Level: 1
DIST-CO-RTE-PM: 03-YOL-50,80-0.0/2.5,4.1/R11.4
Work Description: CRCP, HMA (TYPE A), RDWY EXC, CLASS 2 AB, FIBER OPTIC CABLE SYSTEMS.
Location Description: YOLO COUNTY IN AND NEAR WEST SACRAMENTO ON ROUTE 80 FROM 1.7 MILES EAST OF MACE BOULEVARD OVERCROSSING TO SACRAMENTO RIVER BRIDGE AND OVERHEAD (BRYTE BEND) AND ON ROUTE 50 FROM ROUTE 80 JUNCTION TO JEFFERSON BOULEVARD UNDERCROSSING
Contractor Name: Flat-Iron Teichert A Joint Venture
Contractor Address: 1200 Concord Avenue Suite 465, Concord, CA 94520
Resident Engineer: Mirak Mehari Structure Rep.: Brent Bullard
DIME Sample ID: 2025-11-06-43
TL Number from the TL Form: Sacramento Caltrans lab
Sample Submitted By Organization: Kwik Bond Polymers
Sample Organization Contact: (760) 518-6064
Type of Sample: Quality Control
Type of Material: High Friction Surface Treatment
Sample Taken Date: 11/06/2025
Date that the sample was received by the laboratory/organization performing the testing: 11/07/2025
The quantity of what the sample constitutes: 1 tanker
A brief description of the sample: 1 gallon can HFST Resin
From where was the sample collected: Source
Laboratory sample identification: 000193KBP
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kwik Bond Polymers, Benicia
