Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002183 DEA: 101T3004 EFIS: 1024000229
QA Service Level: 1
DIST-CO-RTE-PM: 10-CAL-var-var
Work Description:
Location Description:
Contractor Name: Myers and sons Construction LLC
Contractor Address: 45 Morrison Avenue, Sacramento, CA, 95838
Resident Engineer: tofael anwar Structure Rep.: Unknown
DIME Sample ID: 2026-06-19-14
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3665 - Sacramento
Sample Organization Contact: (916) 768-8293
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 06/19/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/19/2026
The quantity of what the sample constitutes: Multiple Lanes
A brief description of the sample: Skid Testing Request
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Myers and Sons Construction
