Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994673 DEA: 033F0704 EFIS: 0312000054
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-51-2.0/3.5
Work Description: American River Bridge Rehabilitation
Location Description:
Contractor Name: American River Constructors
Contractor Address: 4001 Bradshaw Road, Sacramento, CA 95827
Resident Engineer: John Ruzic Structure Rep.: Pha Tran
DIME Sample ID: 2025-11-07-68
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Chemistry Laboratory
Sample Organization Contact: (916) 227-7912
Type of Sample: Quality Assurance
Type of Material: Paint
Sample Taken Date: 11/07/2025
Date that the sample was received by the laboratory/organization performing the testing: 11/12/2025
The quantity of what the sample constitutes: 1 QT CAN
A brief description of the sample: PWB-174A
From where was the sample collected: Manufacturer
Laboratory sample identification: C251747
Structure unique identifier:
Structure name: American River Bridge
The fabricator/manufacturer/facility name: Stiles
Batch No.: 3561125
Color: BLACK
Batch size: 150 GAL
Date of Manufacturing: 2011-07-25
Paint Specification: PWB 174
Paint Specification Version: A
DIME Test ID: 2025-11-07-68-5
Test Method: CHEMLP 14- : Pass/Fail
Verified Date: 12/16/2025
Date Tested: 12/16/2025
Submitted By Organization: CT HQ - Sacramento Chemistry Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: sanchita.dey@dot.ca.gov
Organization Phone: (916) 227-7912
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
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Pass/Fail
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Pass
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Reason for failure
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no data
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