Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993131 DEA: 010A1104 EFIS: 0112000211
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-101-27.7
Work Description: BRIDGE SEISMIC RETROFIT AND ROCK SLOPE PROTECTION.
Location Description: HUMBOLDT COUNTY NEAR MYERS FLAT AT SOUTH FORK EEL RIVER BRIDGE
Contractor Name: MERCER-FRASER COMPANY
Contractor Address: 77 2nd St, Eureka, CA 95501
Resident Engineer: Joaquin Rodriguez Structure Rep.: George Moore
DIME Sample ID: 2026-01-12-19
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: Methacrylate
Sample Taken Date: 01/12/2026
Date that the sample was received by the laboratory/organization performing the testing: 01/12/2026
The quantity of what the sample constitutes: 100 Totes
A brief description of the sample: 2 pints 204,chp,zcure,8020
From where was the sample collected: Source
Laboratory sample identification: 000195KBP
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kwik Bond Polymers, Benicia
