Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994673 DEA: 033F0704 EFIS: 0312000054
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-51-2.0/3.5
Work Description: American River Bridge Rehabilitation
Location Description:
Contractor Name: American River Constructors
Contractor Address: 4001 Bradshaw Road, Sacramento, CA 95827
Resident Engineer: John Ruzic Structure Rep.: Pha Tran
DIME Sample ID: 2026-09-30-29
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3665 - Sacramento
Sample Organization Contact: (916) 768-8293
Type of Sample: Acceptance
Type of Material: Methacrylate
Sample Taken Date: 09/30/2026
Date that the sample was received by the laboratory/organization performing the testing: 09/30/2026
The quantity of what the sample constitutes: Multiple Lanes
A brief description of the sample: Skid Test Request (Southbound Both approach slabs)
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 24-0003
Structure name: American River Bridge / Approach
The fabricator/manufacturer/facility name: DBE
