Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002355 DEA: 042X7804 EFIS: 0425000151
QA Service Level: 1
DIST-CO-RTE-PM: 04-NAP-128-19.1/34.3
Work Description:
Location Description: FOR CONSTRUCTION ON STATE HIGHWAY IN NAPA COUNTY FROM 0.6 MILE EAST OF SODA CREEK BRIDGE TO NAPA COUNTY LINE
Contractor Name: Ameer Jibrael
Contractor Address: Unknown
Resident Engineer: Danilo Patenia Structure Rep.: Unknown
DIME Sample ID: 2026-07-24-50
TL Number from the TL Form: 966771
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: 07/24/2026
Date that the sample was received by the laboratory/organization performing the testing: 09/23/2026
The quantity of what the sample constitutes: 1 Quart Bottle
A brief description of the sample: 1 Quart Bottle of PMQCS-1H
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Not on Tl-101 or Bottle
