Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 209695 DEA: 08347704 EFIS: 0800000616
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-SR-58-0/12.9
Work Description: (Alternative Delivery) The CMGC project will upgrade SR 58 from 2- to 4-lanes in San Bernardino County from the Kern County line to 7.5 miles east of US-395.
Location Description: SR-58 / 395 Kramer Junction project. In San Bernardino County from the Kern County line to 7.5 miles east of US-395.
Contractor Name: KIEWIT INFRASTRUCTURE WEST CO.
Contractor Address: 2215 E 1ST STREET, VANCOUVER, WA 98661
Resident Engineer: Shaine Shahidi Structure Rep.: Osama Abdalla
DIME Sample ID: 2019-03-14-5
TL Number from the TL Form:
Sample Submitted By Organization: CT - Unassigned/General Field Laboratory
Sample Organization Contact: 5625005861
Type of Sample: Quality Assurance
Type of Material: Methacrylate
Sample Taken Date: 03/14/2019
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 55 gallons
A brief description of the sample: Methacrylate components
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: KwikBond
