Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001683 DEA: 040AA194 EFIS: 0419000450
QA Service Level: 1
DIST-CO-RTE-PM: 04-CC-4-R29.0/R44.4
Work Description: COLD PLANE AC PVMT, RHMA-G & HMA OVERLAY, REPLACE AC SURF, & MGS.
Location Description: CONTRA COSTA COUNTY IN ANTIOCH AND AT BYRON FROM HILLCREST AVENUE OVERCROSSING TO BYRON HIGHWAY
Contractor Name: GHILOTTI BROS INC
Contractor Address: 523 JACOBY ST, SAN RAFAEL, CA 94901
Resident Engineer: Steven Lee Structure Rep.: Unknown
DIME Sample ID: 2026-05-26-25
TL Number from the TL Form:
Sample Submitted By Organization: CT D04 - Concord Field Laboratory
Sample Organization Contact: (510) 714-7019
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 05/26/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/04/2026
The quantity of what the sample constitutes: 4 boxes
A brief description of the sample: 1/2" WMA-RAP 25
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Materials Vernalis
