Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994871 DEA: 040Q1304 EFIS: 0418000053
QA Service Level: 1
DIST-CO-RTE-PM: 04-SM-1-27.5
Work Description: COLD PLANE AC, PLACE HMA, MODIFY SIGNAL AND LIGHTING SYSTEM.
Location Description: SAN MATEO COUNTY IN AND NEAR HALF MOON BAY FROM WAVECREST ROAD TO 0.1 MILE SOUTH OF MARINE BOULEVARD
Contractor Name: O.C. JONES & SONS, INC.
Contractor Address: Unknown
Resident Engineer: Chetan Sihra Structure Rep.: Abbas Iranmanesh
DIME Sample ID: 2026-07-07-3
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3674 - Pacifica 2
Sample Organization Contact: (510) 714-7639
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 07/07/2026
Date that the sample was received by the laboratory/organization performing the testing:
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: Bay Line
