Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000709 DEA: 041Y6904 EFIS: 0423000015 COOP: NONE
QA Service Level: 1
DIST-CO-RTE-PM: 04-ALA,ALA-92-14.4/18.8
Work Description: ALAMEDA & SAN MATEO HAYWARD TRESTLE REPAIR AND HIGH RISE PIER REPAIR.
Location Description: ALAMEDA AND SAN MATEO COUNTIES AT VARIOUS LOCATIONS FROM 7.0 MILES WEST OF TOLL PLAZA TO 0.2 MILE WEST OF TOLL PLAZA
Contractor Name: GOLDEN STATE BRIDGE
Contractor Address: 3701 Mallard Drive, Benicia, CA 94510
Resident Engineer: Randy Miller Structure Rep.: Bettie Geng
DIME Sample ID: 2026-04-24-34
TL Number from the TL Form: C902229
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Verification
Type of Material: Rapid Set
Sample Taken Date: 04/24/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/27/2026
The quantity of what the sample constitutes: 3 bags
A brief description of the sample: SikaTop 123+
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Sika Corporation
