Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215018 DEA: 051J4804 EFIS: 0517000185
QA Service Level: 1
DIST-CO-RTE-PM: 05-SBT-25,156-54.048
Work Description: SAN BENITO HIGHWAY 25 AT 156 ROUNDABOUT - SAFETY IMPROVEMENTS
Location Description: SAN BENITO COUNTY NEAR HOLLISTER ON ROUTE 25 FROM 0.4 MILE EAST TO 0.3 MILE WEST OF ROUTE 156 AND ON ROUTE 156 FROM 0.4 MILE SOUTH TO 0.3 MILE NORTH OF ROUTE 25
Contractor Name: Granite Rock Company
Contractor Address: 411 Walker Street, Watsonville, CA 95076
Resident Engineer: Baljinder Brar Structure Rep.: Neil Weller
DIME Sample ID: 2020-05-11-25
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - San Luis Obispo District Laboratory
Sample Organization Contact: 8057463562
Type of Sample: Informational
Type of Material: Soil
Sample Taken Date: 05/11/2020
Date that the sample was received by the laboratory/organization performing the testing: 05/11/2020
The quantity of what the sample constitutes: Native Soil
A brief description of the sample: 1 Bag Soil
From where was the sample collected: Job Site
Laboratory sample identification: D5 20-D-018
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Mother Nature
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: 20 feet from WB SR 25 EP
Where the material sample would have been placed if not sampled: Unknown
