Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001110 DEA: 06484674 EFIS: 0623000083 COOP: 061794
QA Service Level: 2
DIST-CO-RTE-PM: 06-KER--
Work Description:
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Albert Heredia
DIME Sample ID: 2026-04-09-6
TL Number from the TL Form:
Sample Submitted By Organization: Accenture
Sample Organization Contact: (714) 588-7850
Type of Sample: Quality Assurance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 04/09/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/09/2026
The quantity of what the sample constitutes: 3000 CF
A brief description of the sample: CRCP
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Golden Empire - Bakersfield
Pavement Surface Type: CRCP (Continuously Reinforced Concrete Pavement)
Type of Traffic Control Provided: Behind K-Rail/Barrier
DIST-CO-RTE:
Direction of Travel:
Post Mile:
Lanes to be Tested:
Station:
