Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212246 DEA: 053307A4 EFIS: 0514000027
QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO-46-49.7/54.6
Work Description: Cholame Segment
Location Description:
Contractor Name: Atkinson Construction
Contractor Address: 18201 Von Karman - Suite 800, Irvine, CA 92612
Resident Engineer: Andrew Borrelli Structure Rep.: Dave Lewis
DIME Sample ID: 2022-06-07-10
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Whitley Gardens Field Laboratory
Sample Organization Contact: 805-540-9933
Type of Sample: Quality Assurance
Type of Material: Soil
Sample Taken Date: 06/07/2022
Date that the sample was received by the laboratory/organization performing the testing: 06/07/2022
The quantity of what the sample constitutes: native material 5 shot
A brief description of the sample: Native Soil for Subgrade
From where was the sample collected: Job Site
Laboratory sample identification: 37041native3
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Native Material Subgrade
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: Native Subgrade
Where the material sample would have been placed if not sampled:
