Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000603 DEA: 051K4504 EFIS: 0518000209
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-R52.3/R56.1
Work Description: COLD PLANE AND RHMA/HMA ROADWAY AND BRIDGE, & REPLACE CULVERTS.
Location Description: SANTA BARBARA COUNTY NEAR BUELLTON FROM OLD COAST HIGHWAY TO 0.4 MILE SOUTH OF SANTA ROSA ROAD OVERCROSSING
Contractor Name: CALPORTLAND CONSTRUCTION
Contractor Address: Unknown
Resident Engineer: Jason Torres Structure Rep.: Cliff Raplogle
DIME Sample ID: 2026-02-11-13
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: Polyester
Sample Taken Date: 02/11/2026
Date that the sample was received by the laboratory/organization performing the testing: 02/12/2026
The quantity of what the sample constitutes: 34 Totes
A brief description of the sample: 1 gallon can / PPC 1121 RESIN
From where was the sample collected: Source
Laboratory sample identification: 000200KBP
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kwik Bond Polymers, Benicia
