Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215042 DEA: 100TST04 EFIS: 1020999999
QA Service Level: 1
DIST-CO-RTE-PM: 10-STA-5-26.1/27.0
Work Description: This is just a test EA, not tied to an actual project at all. Don't believe anything you read.
Location Description:
Contractor Name: ZZ-Acme Construction
Contractor Address: 1234 Main Street, AnyTown, CA 98765
Resident Engineer: Thomas Tutone Structure Rep.: Unknown
DIME Sample ID: 2026-05-01-5
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Hot Mix Asphalt Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Acceptance
Type of Material: Full Depth Recycling
Sample Taken Date: 05/01/2026
Date that the sample was received by the laboratory/organization performing the testing: 05/01/2026
The quantity of what the sample constitutes: 3 dry 3 wet
A brief description of the sample: specimens
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: T
