Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002537 DEA: 051S6204 EFIS: 0525000067
QA Service Level: 1
DIST-CO-RTE-PM: 05-SBT-25-49.8/51.7
Work Description:
Location Description:
Contractor Name: Enduaro Sanchez
Contractor Address: P.O.Box 1819, snoqualmie, WA 98065
Resident Engineer: Hekmatullah Parsa Structure Rep.: Unknown
DIME Sample ID: 2026-08-18-88
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: 08/18/2026
Date that the sample was received by the laboratory/organization performing the testing: 09/09/2026
The quantity of what the sample constitutes: 1 jug of MSE
A brief description of the sample: NORA
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: WESTERN EMULISON IRWINDALE
