Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002358 DEA: 070Y0104 EFIS: 0723000268
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-101-VAR
Work Description: RTE 101 BRIDGES - POLYESTER CONCRETE OVERLAY, METHACRYLATE DECK TREATMENT, JOINT SEALS, DECK REPAIR, AC CONFORM & PAVEMENT DELINEATION (21 BRIDGES, MISSION RD ONRAMP UC TO KANAN RD OC)
Location Description:
Contractor Name: J Franics Company
Contractor Address: 16194 Krameria Ave, Riverside, CA 92504
Resident Engineer: Denrick Bautista Structure Rep.: Unknown
DIME Sample ID: 2026-08-04-6
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3670 - Glendale
Sample Organization Contact: 2133170314
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 08/04/2026
Date that the sample was received by the laboratory/organization performing the testing: 08/04/2026
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: 53-0731
Structure name: Wilton Place Overcrossing
The fabricator/manufacturer/facility name: J Francies
Pavement Surface Type: Polyester Concrete
Type of Traffic Control Provided: Moving Lane Closure
DIST-CO-RTE: 07-LA-101
Direction of Travel: North
Post Mile: 6.15
Lanes to be Tested: Shoulder
Station:
