Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994443 DEA: 053307C4 EFIS: 0514000028
QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO-41,46-44.5/45.3,54.0/57.8
Work Description: Wye Segment - Route 41/46 Separation
Location Description:
Contractor Name: Atkinson Construction
Contractor Address: 18201 Von Karman - Suite 800, Irvine, CA 92612
Resident Engineer: Brian Harrington Structure Rep.: Dave Lewis
DIME Sample ID: 2026-01-06-2
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Millbrook Field Laboratory
Sample Organization Contact: (559) 341-3953
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 01/06/2026
Date that the sample was received by the laboratory/organization performing the testing: 01/06/2026
The quantity of what the sample constitutes: Bridge- 2 Lanes and shoulders
A brief description of the sample: Skid Testing Request
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 49-0277 L
Structure name: Cholame Creek Overflow Bridge Left
The fabricator/manufacturer/facility name: ATKINSON CONSTRUCTION
Pavement Surface Type: PCC (Portland Cement Concrete)
Type of Traffic Control Provided: N/A
DIST-CO-RTE: 05-SLO-46
Direction of Travel: East
Post Mile:
Lanes to be Tested: Shoulder,Lane #1,Lane #2
Station: 1370+05.00
