Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215038 DEA: 051J7804 EFIS: 0518000052
QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO-101-61.88/61.88
Work Description: SAFETY IMPROVEMENTS
Location Description: WELLSONA SAFETY IMPROVEMENTS, SLO 101
Contractor Name: CALPORTLAND CONSTRUCTION
Contractor Address: 1625 East Donovan Road, Santa Maria, Ca 93456
Resident Engineer: Michael Schmidt Structure Rep.: Ye Yang
DIME Sample ID: 2026-03-04-1
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Fresno Construction Field Office
Sample Organization Contact: (559) 243-3828
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 03/04/2026
Date that the sample was received by the laboratory/organization performing the testing: 03/10/2026
The quantity of what the sample constitutes: Multiple Lanes
A brief description of the sample: Skid Testing Request
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 49-0279R
Structure name: NB Wellsona Road UC
The fabricator/manufacturer/facility name: CalPortland Paso Robles
Pavement Surface Type: PCC (Portland Cement Concrete)
Type of Traffic Control Provided: N/A
DIST-CO-RTE: 05-SLO-101-61.7/62.1
Direction of Travel: North
Post Mile:
Lanes to be Tested: Shoulder,Lane #1,Lane #2
Station: 61.8
