Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000775 DEA: 022J9704 EFIS: 0221000154
QA Service Level: 1
DIST-CO-RTE-PM: 02-SHA-5,89-Var
Work Description: BRIDGE POLYESTER CONCRETE OVERLAY AND METHACRYLATE DECK SEAL.
Location Description: SHASTA COUNTY ON ROUTE 5 AT VARIOUS LOCATIONS FROM ANTLER UNDERCROSSING TO SODA CREEK ROAD UNDERCROSSING AND ON ROUTE 89 AT VARIOUS LOCATIONS FROM HAT CREEK BRIDGE NO. 06-0085 TO CAYTON CREEK BRIDGE
Contractor Name: MCCUEN CONSTRUCTION, INC.
Contractor Address: 3269 SWETZER ROAD, Loomis CA 95650
Resident Engineer: Kyle Higgins Structure Rep.: Chris Brace
DIME Sample ID: 2026-08-27-12
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3667 - Redding
Sample Organization Contact: (530) 218-4794
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 08/27/2026
Date that the sample was received by the laboratory/organization performing the testing: 08/27/2026
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: 06-0028
Structure name: Slate Creek Bridge
The fabricator/manufacturer/facility name: McCuen Construction
Pavement Surface Type: Polyester Concrete
Type of Traffic Control Provided: Stationary Lane Closure
DIST-CO-RTE: 02-Sha-5
Direction of Travel:
Post Mile: 48.83
Lanes to be Tested: Lane #1,Lane #2
Station:
