Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215789 DEA: 10462104 EFIS: 1013000266
QA Service Level: 1
DIST-CO-RTE-PM: 10-TUO-108-R18.9/38.8
Work Description: COLD PLANE, HMA, DRAINAGE REPLACEMENT, AND MODIFY TRAFFIC STATIONS.
Location Description: TUOLUMNE COUNTY IN AND NEAR LONG BARN FROM 0.1 MILE WEST OF LONG BARN ROAD TO 2.3 MILES EAST OF COW CREEK ROAD
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Shamsurahman Sheenwari Structure Rep.: Unknown
DIME Sample ID: 2022-07-07-51
TL Number from the TL Form: 034426
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: 07/07/2022
Date that the sample was received by the laboratory/organization performing the testing: 07/08/2022
The quantity of what the sample constitutes: 4 boxes
A brief description of the sample: 3/4 HMA-A
From where was the sample collected: Manufacturer
Laboratory sample identification: 22-H-082
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: GRI, Table MTN
