Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001218 DEA: 010M9604 EFIS: 0123000106
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-101,271-Var
Work Description: POLYESTER CONCRETE OVERLAY, HMA, & COLD PLANE AC PAVEMENT.
Location Description: MENDOCINO COUNTY AT VARIOUS LOCATIONS
Contractor Name: MCCUEN CONSTRUCTION, INC.
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2026-04-23-5
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3667 - Redwood Valley/Fort Bragg
Sample Organization Contact: (707) 498-1012
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 04/23/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/23/2026
The quantity of what the sample constitutes: Trial Slab and 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: 10-0204L
Structure name: Moore Street UC
The fabricator/manufacturer/facility name: Kwitbond Polymers
Pavement Surface Type: Polyester Concrete
Type of Traffic Control Provided: Behind K-Rail/Barrier
DIST-CO-RTE: 01-MEN-101
Direction of Travel: South
Post Mile:
Lanes to be Tested: Lane #1,Lane #2
Station: 30.43
