Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002224 DEA: 010N9504 EFIS: 0124000146
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-101,299-unknown
Work Description:
Location Description:
Contractor Name: Justin Herbert
Contractor Address: 3221 Rippey Road, Loomis, CA, 95650
Resident Engineer: Oppen Emma Structure Rep.: Unknown
DIME Sample ID: 2026-06-17-8
TL Number from the TL Form:
Sample Submitted By Organization: CT D01 - District 1 Materials Laboratory
Sample Organization Contact: (707) 496-0974
Type of Sample: Quality Assurance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 06/17/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/17/2026
The quantity of what the sample constitutes: Skid Testing
A brief description of the sample: Portable Skid Test
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Job Site
Pavement Surface Type: Polyester Concrete
Type of Traffic Control Provided: Stationary Lane Closure
DIST-CO-RTE: 01-SB-101
Direction of Travel: South
Post Mile: 84.70
Lanes to be Tested: Lane #2
Station:
