Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214337 DEA: 080E33U4 EFIS: 0817000075
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-115-R7.3/R10.0
Work Description: ADD WB AUX & EB DECEL LANES, WIDEN I15 SW CONNECT,RAMPS/BRDG
Location Description: SAN BERNARDINO COUNTY IN ONTARIO FROM 0.2 MILE WEST OF CUCAMONGA CREEK BRIDGE TO MILLIKEN AVENUE
Contractor Name: Ames Construction
Contractor Address: 391 North Main Street, Suite 302, Corona, CA 92880
Resident Engineer: Denise Sostrom Structure Rep.: Matt Bruce
DIME Sample ID: 2019-07-11-19
TL Number from the TL Form: 8644
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Per Request
Type of Material: Soil
Sample Taken Date: 07/11/2019
Date that the sample was received by the laboratory/organization performing the testing: 07/11/2019
The quantity of what the sample constitutes: 1 bag
A brief description of the sample: Soil
From where was the sample collected: Job Site
Laboratory sample identification: 8644
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Caltrans
The fabricator's/manufacturer's product name for the sample: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: A-19-008
Where the material sample would have been placed if not sampled: Unknown
