Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215343 DEA: 031J1704 EFIS: 0320000114
QA Service Level: 1
DIST-CO-RTE-PM: 03-PLA,NEV-89-13.0/21.6,0.0/0.6
Work Description: DRAINAGE IMPROVEMENTS.
Location Description: PLACER AND NEVADA COUNTIES IN AND NEAR TRUCKEE ON ROUTE 89 FROM 0.8 MILE NORTH OF ALPINE MEADOWS ROAD TO NEVADA COUNTY AND FROM PLACER COUNTY LINE TO ROUTE 80
Contractor Name: A. TEICHERT & SON, INC. DBA TEICHERT CONSTRUCTION
Contractor Address: 4401 Duluth Avenue, Rocklin, CA 95765
Resident Engineer: Christopher (Kimo) Rebollo Structure Rep.: Unknown
DIME Sample ID: 2026-06-01-52
TL Number from the TL Form:
Sample Submitted By Organization: Blackburn Consulting
Sample Organization Contact: (916) 375-8706
Type of Sample: Preliminary
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:
The quantity of what the sample constitutes: 12 boxes, 10 bags, 2 oil can
A brief description of the sample: JMF Verification
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Martis Valley
