Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 77777 DEA: CHEM-STOCK EFIS: CHEM-STOCK
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for Chem Lab stock material. Object Code: 1025. J2 DEA: 912680.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2026-01-23-36
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Chemistry Laboratory
Sample Organization Contact: (916) 227-7912
Type of Sample: Quality Assurance
Type of Material: Glass Beads
Sample Taken Date: 01/23/2026
Date that the sample was received by the laboratory/organization performing the testing: 02/03/2026
The quantity of what the sample constitutes: (2) 1 QT CANS
A brief description of the sample: 8010-004 CA MP II
From where was the sample collected: Manufacturer
Laboratory sample identification: C260135
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: POTTERS IND. (AZ)
DIME Test ID: 2026-01-23-36-4
Test Method: CHEMLP 14- : Pass/Fail
Verified Date: 03/24/2026
Date Tested: 02/12/2026
Submitted By Organization: CT HQ - Sacramento Chemistry Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: sanchita.dey@dot.ca.gov
Organization Phone: (916) 227-7912
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
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Pass/Fail
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Pass
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Reason for failure
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no data
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