Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002370 DEA: 112N2094 EFIS: 1123000288
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-8,67-11-SD-8, 67-Var
Work Description:
Location Description:
Contractor Name: TRUESDELL CORPORATION OF CALIFORNIA INC
Contractor Address: 1310 W 23RD STREET, TEMPE AZ 85282
Resident Engineer: Alex Balce Structure Rep.: Unknown
DIME Sample ID: 2026-10-09-19
TL Number from the TL Form: Sacramento Caltrans lab
Sample Submitted By Organization: Kwik Bond Polymers
Sample Organization Contact: (760) 518-6064
Type of Sample: Quality Control
Type of Material: Polyester
Sample Taken Date: 10/09/2026
Date that the sample was received by the laboratory/organization performing the testing: 10/13/2026
The quantity of what the sample constitutes: 10 TANKERS
A brief description of the sample: 1 gallon can / PPC 1121 RESIN
From where was the sample collected: Source
Laboratory sample identification: 000233KBP
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kwik Bond Polymers, Benicia
