Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002171 DEA: 101U0504 EFIS: 1025000085
QA Service Level: 1
DIST-CO-RTE-PM: 10-UNKNOWN--unknown
Work Description:
Location Description:
Contractor Name: George Reed Inc
Contractor Address: 1156 scenic Drive suite 200, Modesto, CA, 95350
Resident Engineer: Jonathon Ngai Structure Rep.: Unknown
DIME Sample ID: 2026-06-01-44
TL Number from the TL Form: C039410
Sample Submitted By Organization: CT D10 - District 10 Materials Laboratory
Sample Organization Contact: (209) 948-7567
Type of Sample: Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 06/01/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/03/2026
The quantity of what the sample constitutes: 6 Boxes of 3/4" HMA-A-SP with RAP
A brief description of the sample: 3/4 HMA-A Pg-58-34
From where was the sample collected: Supplier
Laboratory sample identification: 26-H-018
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: George Reed - Table Mountain Plant
