Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001169 DEA: 07314524 EFIS: 0722000300 COOP: 075283
QA Service Level: 2
DIST-CO-RTE-PM: 07---
Work Description: I-105 METRO Express Lanes Project
Location Description: LA-105 PM R0.6/R10.1, LA-110 PM R14.1/R16.6
Contractor Name: Flatiron-Myers (JV)
Contractor Address: Unknown
Resident Engineer: Joahnna Vergara Structure Rep.: James Holloway
DIME Sample ID: 2026-09-15-7
TL Number from the TL Form:
Sample Submitted By Organization: Caltrans IA
Sample Organization Contact: (916) 240-3821
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 09/15/2026
Date that the sample was received by the laboratory/organization performing the testing: 10/12/2026
The quantity of what the sample constitutes: Skid Test Request
A brief description of the sample: Skid Test Request
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Flatiron Dragados
Pavement Surface Type: PCC (Portland Cement Concrete)
Type of Traffic Control Provided: Behind K-Rail/Barrier
DIST-CO-RTE: 07-LA-105
Direction of Travel: West
Post Mile: 4.20
Lanes to be Tested: Shoulder
Station:
