Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002496 DEA: 031N4204 EFIS: 0325000024
QA Service Level: 1
DIST-CO-RTE-PM: 03-SIE-89-6.2/6.4
Work Description: D03 SIERRA RTE 89 (PM 6.2/6.4) NEAR SIERRAVILLE - COLD PLANE ASPHALT, DITCH EXCAVATION, PAINT TRAFFIC STRIPE. CONTRACT 03-1N4204, RE CHRISTOPHER REBOLLO.
Location Description:
Contractor Name: ALL-AMERICAN CONSTRUCTION, INC.
Contractor Address: 1700 Acacia Avenue, Sutter, CA 95982
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2026-09-09-21
TL Number from the TL Form:
Sample Submitted By Organization: Blackburn Consulting
Sample Organization Contact: (916) 375-8706
Type of Sample: Quality Assurance
Type of Material: Bituminous Adhesive
Sample Taken Date: 09/09/2026
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 tack oil
A brief description of the sample: tack oil
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: PNW
