Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993169 DEA: 050A0904 EFIS: 0513000028
QA Service Level: 1
DIST-CO-RTE-PM: 05-MON-156-R1.4/R2.0
Work Description: WIDEN REINFORCED STRUCTURAL CONCRETE BRIDGE & REPLACE BRIDGE RAILING.
Location Description: MONTEREY COUNTY IN AND NEAR CASTROVILLE FROM 0.3 MILE EAST OF ROUTE 156/183 SEPARATION TO 0.2 MILE EAST OF CASTROVILLE BOULEVARD
Contractor Name: Granite Rock (Bryan Jones)
Contractor Address: 5225 Hellyer Ave, Ste 220, San Jose, CA 95138
Resident Engineer: David Hopper Structure Rep.: Dean Russu
DIME Sample ID: 2022-05-06-8
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - San Luis Obispo District Laboratory
Sample Organization Contact: (559) 230-3109
Type of Sample: Annual Source Testing
Type of Material: Hot Mix Asphalt
Sample Taken Date: 05/06/2022
Date that the sample was received by the laboratory/organization performing the testing: 05/12/2022
The quantity of what the sample constitutes: 750
A brief description of the sample: mix
From where was the sample collected: Source
Laboratory sample identification: numbers
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: plant
