Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214700 DEA: 030F2804 EFIS: 0312000069
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-99-7.1/9.4
Work Description: Dillard Overcrossing and McConnel Overhead
Location Description: Hwy 99, Elk Grove, CA
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 4001 Bradshaw Road, Sacramento, CA 95827
Resident Engineer: Saed Masoud Structure Rep.: Chau Ha
DIME Sample ID: 2021-05-17-4
TL Number from the TL Form: c850179
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: 05/17/2021
Date that the sample was received by the laboratory/organization performing the testing: 05/18/2021
The quantity of what the sample constitutes: 1 jag
A brief description of the sample: SS-1h
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Jobsite
