Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994673 DEA: 033F0704 EFIS: 0312000054
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-51-2.0/3.5
Work Description: American River Bridge Rehabilitation
Location Description:
Contractor Name: American River Constructors
Contractor Address: 4001 Bradshaw Road, Sacramento, CA 95827
Resident Engineer: John Ruzic Structure Rep.: Pha Tran
DIME Sample ID: 2026-01-29-48
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: Paint
Sample Taken Date: 01/29/2026
Date that the sample was received by the laboratory/organization performing the testing: 02/03/2026
The quantity of what the sample constitutes: 1 QT CAN
A brief description of the sample: D3 North, Atlas COLOR #37031
From where was the sample collected: Manufacturer
Laboratory sample identification: C260133
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Stiles Paint
Batch Number: 561126
Color: BLACK
Batch size: 150 GALLONS
Date of Manufacturing: 0000-00-00
Paint Specification: PWB 174
Paint Specification Version: A
