Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993603 DEA: 051N7004 EFIS: 0521000081
QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO-166-16.0/21.0
Work Description: PARTIAL DEPTH RECYCLING AND OVERLAY WITH RHMA (GAP GRADED).
Location Description: SAN LUIS OBISPO COUNTY ABOUT 8 MILES EAST OF SANTA MARIA FROM 0.5 MILE WEST OF HUASNA RIVER BRIDGE TO 1.9 MILES WEST OF CUYAMA RIVER BRIDGE.
Contractor Name: PAPICH CONSTRUCTION COMPANY INC.
Contractor Address: Unknown
Resident Engineer: Thomas Petersen Structure Rep.: Unknown
DIME Sample ID: 2022-07-12-38
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - San Luis Obispo District Laboratory
Sample Organization Contact: 8057463562
Type of Sample: Informational
Type of Material: Partial Depth Recycling
Sample Taken Date: 07/12/2022
Date that the sample was received by the laboratory/organization performing the testing: 07/13/2022
The quantity of what the sample constitutes: Test Strip, Lot 1, Lot 2
A brief description of the sample: 18 PDR pucks
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Papich Subcontractor
