Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001575 DEA: 061H9604 EFIS: 0625000104
QA Service Level: 1
DIST-CO-RTE-PM: 06-KER-46,119-VAR
Work Description: COLD PLANE AC PAVEMENT AND PLACING RHMA TYPE G.
Location Description: KERN COUNTY AT VARIOUS LOCATIONS
Contractor Name: Griffith Company (Edward Torres)
Contractor Address: 1128 Carrier Parkway Avenue, Bakersfield, CA 93308
Resident Engineer: Alejandro Ruezga Structure Rep.: Unknown
DIME Sample ID: 2026-04-28-41
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: No Test
Type of Material: Asphaltic Emulsion
Sample Taken Date: 04/28/2026
Date that the sample was received by the laboratory/organization performing the testing: 05/04/2026
The quantity of what the sample constitutes: 1 JUG OF SS-1H
A brief description of the sample: SS-1H
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: emultech bakersfield
