Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213929 DEA: 060W6804 EFIS: 0617000281
QA Service Level: 1
DIST-CO-RTE-PM: 06-KER-155-30.3/49.5
Work Description: COLD PLANE EXISTING PAVEMENT AND PLACE HMA (TYPE A).
Location Description: KERN COUNTY NEAR GLENNVILLE AT VARIOUS LOCATIONS FROM DELANO WOODY ROAD TO 2.4 MILES NORTH OF SANDY CREEK FIRE ROAD
Contractor Name: GRIFFITH COMPANY
Contractor Address: 3050 E BIRCH STREET, BREA CA 92821
Resident Engineer: Structure Rep.: Unknown
DIME Sample ID: 2019-08-13-8
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Hot Mix Asphalt Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Dispute Resolution
Type of Material: Hot Mix Asphalt
Sample Taken Date: 08/13/2019
Date that the sample was received by the laboratory/organization performing the testing: 08/09/2019
The quantity of what the sample constitutes: 1
A brief description of the sample: 1/2 inch HMA-A
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Griffith construction
