Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215793 DEA: 043G4874 EFIS: 0412000087
QA Service Level: 1
DIST-CO-RTE-PM: 04-SF-80-5.7/7.7
Work Description: REPAIR SPALL, CLEAN AND PAINT STRUCTURAL STEEL BRIDGE, AND ELECTRICAL.
Location Description: THE CITY AND COUNTY OF SAN FRANCISCO FROM 0.1 MILE EAST OF FREMONT STREET OFF-RAMP TO 0.2 MILE WEST OF YERBA BUENA ISLAND OFF-RAMP
Contractor Name: F.D. Thomas (Zackary Sowers)
Contractor Address: 217 Bateman Drive, Central Point, OR 97502
Resident Engineer: omar Plata Structure Rep.: Sergio Gomez
DIME Sample ID: 2026-06-10-14
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Vallejo Field Laboratory
Sample Organization Contact: 9166394315
Type of Sample: Quality Assurance
Type of Material: Rapid Set
Sample Taken Date: 06/10/2026
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 41,921 sqft repair
A brief description of the sample: Repair Spall with fiber reinforced filler
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Planitop X
