Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215086 DEA: 101G7504 EFIS: 1017000036
QA Service Level: 1
DIST-CO-RTE-PM: 01-MER,SJ,STA-5,59,99,152-Var
Work Description: UPGRADE TRAFFIC MONITORING STATIONS.
Location Description: MERCED, SAN JOAQUIN AND STANISLAUS COUNTIES AT VARIOUS LOCATIONS.
Contractor Name: BENTANCOURT BROS. CONSTRUCTION INC.
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2021-10-28-46
TL Number from the TL Form: C035069
Sample Submitted By Organization: CT D10 - District 10 Materials Laboratory
Sample Organization Contact: (209) 948-7567
Type of Sample: Verification
Type of Material: Hot Mix Asphalt
Sample Taken Date: 10/28/2021
Date that the sample was received by the laboratory/organization performing the testing: 11/01/2021
The quantity of what the sample constitutes: 16 boxes of mix
A brief description of the sample: 3/4 HMA-A -R12%
From where was the sample collected: Manufacturer
Laboratory sample identification: C035069
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Materials Vernalis
