Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994539 DEA: 021H58U4 EFIS: 0223000059
QA Service Level: 1
DIST-CO-RTE-PM: 02-PLU-70-58.2/R78.4
Work Description: RECONSTRUCT ROADWAY, HMA PAVING, DRAINAGE AND ELECTRICAL WORK.
Location Description: PLUMAS COUNTY AT AND NEAR CROMBERG FROM GILL RANCH ROAD TO 0.2 MILE WEST OF BIG GRIZZLY CREEK BRIDGE
Contractor Name: MERCER-FRASER COMPANY
Contractor Address: PO Box 1006, Eureka, CA 95502
Resident Engineer: Mike Zdenek Structure Rep.: Brandon Thurber
DIME Sample ID: 2026-08-07-41
TL Number from the TL Form:
Sample Submitted By Organization: Pavement Engineering, Incorporated
Sample Organization Contact: (530) 224-4535
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 08/07/2026
Date that the sample was received by the laboratory/organization performing the testing: 08/17/2026
The quantity of what the sample constitutes: 483 Tons
A brief description of the sample: 3/4 HMA A 15rap PG64-28m
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Aggregates - Martis
