Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214531 DEA: 043J3204 EFIS: 0415000131
QA Service Level: 1
DIST-CO-RTE-PM: 04-SCL,SM-280-11.5/20.6
Work Description: Replace PCC slabs, resurface AC, place curb ramps and guardrails IN LOS ALTOS HILLS AND MENLO PARK FROM FOOTHILL EXPRESSWAY UNDERCROSSING TO 0.5 MILE NORTH OF SAND HILL ROAD OVERCROSSING
Location Description:
Contractor Name: OC Jones
Contractor Address: 1520 Fourth Street, Berkeley, CA 94710
Resident Engineer: Eunmi Choi Structure Rep.: Unknown
DIME Sample ID: 2020-06-29-44
TL Number from the TL Form: 811371
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Department Acceptance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 06/29/2020
Date that the sample was received by the laboratory/organization performing the testing: 08/20/2020
The quantity of what the sample constitutes: 1 can
A brief description of the sample: ss-1h emulsion
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: pacific northwest oil
