Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001946 DEA: 040P9004 EFIS: 0418000024
QA Service Level: 1
DIST-CO-RTE-PM: 04-ALA-580-R41.3 to R44.8
Work Description:
Location Description:
Contractor Name: GOLDEN STATE BRIDGE
Contractor Address: Unknown
Resident Engineer: Jasmaninder Singh Structure Rep.: Jingan Chen
DIME Sample ID: 2026-08-24-26
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Quality Assurance
Type of Material: Rapid Set
Sample Taken Date: 08/24/2026
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 1 bag
A brief description of the sample: SikaQuick 2500 50 lb bag
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Sika Corporation
