Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000925 DEA: 010M6304 EFIS: 0123000050
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-211-R74.2/79.3
Work Description: MICRO-SURFACING, REPLACE AC SURFACING, AND DELINEATION.
Location Description: HUMBOLDT COUNTY IN AND NEAR FERNDALE FROM 0.4 MILE SOUTH OF SALT RIVER OVERFLOW TO SINGLEY ROAD
Contractor Name: DRYCO CONSTRUCTION, INC. DBA DRYCO
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2026-07-13-37
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: No Test
Type of Material: Asphaltic Emulsion
Sample Taken Date: 07/13/2026
Date that the sample was received by the laboratory/organization performing the testing: 07/21/2026
The quantity of what the sample constitutes: 2 jugs
A brief description of the sample: 2 jugs of CSS-1H
From where was the sample collected: Other
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: VSS Emultech West Sac
