Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994539 DEA: 021H58U4 EFIS: 0223000059
QA Service Level: 1
DIST-CO-RTE-PM: 02-PLU-70-58.2/R78.4
Work Description: RECONSTRUCT ROADWAY, HMA PAVING, DRAINAGE AND ELECTRICAL WORK.
Location Description: PLUMAS COUNTY AT AND NEAR CROMBERG FROM GILL RANCH ROAD TO 0.2 MILE WEST OF BIG GRIZZLY CREEK BRIDGE
Contractor Name: MERCER-FRASER COMPANY
Contractor Address: PO Box 1006, Eureka, CA 95502
Resident Engineer: Mike Zdenek Structure Rep.: Brandon Thurber
DIME Sample ID: 2026-04-15-41
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: 04/15/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/16/2026
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: 000209KBP
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kwik Bond Polymers, Benicia
