Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214492 DEA: 033F5404 EFIS: 0313000136
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-99,160-4.5/5.7,R44.5
Work Description: FURNISH PRECAST PRESTRESSED CONCRETE SLAB & PLACE STRUCTURAL CONCRETE.
Location Description: SACRAMENTO COUNTY NEAR GALT ON ROUTE 99 FROM NORTH OF MINGO ROAD TO SOUTH OF ARNO ROAD OVERCROSSING AND IN SACRAMENTO ON ROUTE 160 AT AMERICAN RIVER BRIDGE
Contractor Name: BROSAMER & WALL, INC.
Contractor Address: 5000 Marsh Drive, Suite 300, Conord, CA 94520
Resident Engineer: Mohssen Ghassemi Structure Rep.: Chris Quon
DIME Sample ID: 2020-04-14-39
TL Number from the TL Form: 0034589
Sample Submitted By Organization: CT D02 - Redding Northern Regional Laboratory
Sample Organization Contact: (530) 225-3194
Type of Sample: Verification
Type of Material: Reclaimed Asphalt Pavement
Sample Taken Date: 04/14/2020
Date that the sample was received by the laboratory/organization performing the testing: 04/24/2020
The quantity of what the sample constitutes: JMF Verification
A brief description of the sample: RAP
From where was the sample collected: Manufacturer
Laboratory sample identification: D03 Sample
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Perkins Plant
