Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 209511 DEA: 080Q7403 EFIS: 0800020456
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15-15.4/30.8
Work Description: Design Build project provides pavement rehabilitation (including ramps) on I-15 near Cajon Pass, CA.
Location Description: On I-15 from 0.4 mile north of Kenwood Avenue to 0.3 mile south of West Hesperia OH
Contractor Name: Coffman Specialties, Inc./Parsons Transportation Group, Inc
Contractor Address: 9685 VIA EXCELENCIA, SUITE 200, SAN DIEGO, CA 92126
Resident Engineer: Maged Youssef Structure Rep.: Unknown
DIME Sample ID: 2014-06-28-7304172
TL Number from the TL Form:
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: 06/28/2014
Date that the sample was received by the laboratory/organization performing the testing: 06/30/2014
The quantity of what the sample constitutes: 1 Bag
A brief description of the sample: Soil
From where was the sample collected: Source
Laboratory sample identification: 4174B
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: SBd-15-PM 26.75-S/B
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: SBd-15-PM 26.75-S/B
Where the material sample would have been placed if not sampled:
