Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002421 DEA: 033G2104 EFIS: 0323000222
QA Service Level: 1
DIST-CO-RTE-PM: 03-UNKNOWN,PLA-,80-
Work Description: BRIDGE DECK REHAB RTE 20/80 NEVADA-PLACER: REMOVE & PLACE POLYESTER CONCRETE OVERLAY, JOINT SEAL (MR 1\\\\"), BONDED JOINT SEAL, RSC PATCH, REPAIR SPALLED AREAS, TREAT BRIDGE DECK, CLEAN & PAINT STRUCTURAL STEEL, THERMO STRIPING
Location Description:
Contractor Name: MYERS & SONS CONSTRUCTION, LLC
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2026-09-23-3
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Concrete Testing Laboratory
Sample Organization Contact: (916) 206-4373
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 09/23/2026
Date that the sample was received by the laboratory/organization performing the testing: 09/23/2026
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:
Structure name:
The fabricator/manufacturer/facility name: Myers and Sons Construction
Pavement Surface Type: Polyester Concrete
Type of Traffic Control Provided: Stationary Lane Closure
DIST-CO-RTE: 03-Pla-80
Direction of Travel: East
Post Mile:
Lanes to be Tested: Shoulder,Lane #1,Lane #2
Station: R65.00
