Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001963 DEA: 051S3204 EFIS: 0524000214
QA Service Level: 1
DIST-CO-RTE-PM: 05-SCR--unknown
Work Description: Bridge Prev Maint SBt and SCr Counties
Location Description:
Contractor Name: Trusdell Corporation Of California
Contractor Address: Unknown
Resident Engineer: Azin Sadeghi Structure Rep.: Daniel Dait
DIME Sample ID: 2026-05-14-24
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3675 - Santa Cruz Field Office
Sample Organization Contact: (925) 285-1217
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 05/14/2026
Date that the sample was received by the laboratory/organization performing the testing: 05/14/2026
The quantity of what the sample constitutes: 12'x12'x1" Trial Panel
A brief description of the sample: Skid Test Request
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Truesdell Corp.
Pavement Surface Type: Polyester Concrete
Type of Traffic Control Provided: N/A
DIST-CO-RTE: 05-SCr-001
Direction of Travel: North
Post Mile:
Lanes to be Tested: Off Ramp
Station:
