Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001369 DEA: 010K1504 EFIS: 0120000035
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-101-125.2/R126.1
Work Description: EARTHWORK, HMA-A, DRAINAGE, AND HIGH FRICTION SURFACE TREATMENT.
Location Description: HUMBOLDT COUNTY NEAR ORICK FROM 0.9 MILE SOUTH TO SOUTH PRAIRIE CREEK PARK UNDERCROSSING
Contractor Name: G R SUNDBERG INC
Contractor Address: 5211 Boyd Road, Arcata, CA 95521
Resident Engineer: Ryan Dunne Structure Rep.: Unknown
DIME Sample ID: 2026-02-05-24
TL Number from the TL Form: 198KBP
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: 02/05/2026
Date that the sample was received by the laboratory/organization performing the testing: 02/16/2026
The quantity of what the sample constitutes: 32 Totes
A brief description of the sample: 1 gallon can / HFST RESIN
From where was the sample collected: Source
Laboratory sample identification: 26-002
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kwik Bond Polymers, Benicia
