Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993521 DEA: 032G3504 EFIS: 0321000116
QA Service Level: 1
DIST-CO-RTE-PM: 03-COL-20-30.5/31.8
Work Description: HMA (TYPE A) AND CHIP SEAL.
Location Description: COLUSA COUNTY IN COLUSA FROM SIOC STREET TO FIRST STREET
Contractor Name: LAMON CONSTRUCTION
Contractor Address: 871 Von Geldern Way, Yuba City, cA 95991
Resident Engineer: Michael Mattson Structure Rep.: Unknown
DIME Sample ID: 2022-09-15-80
TL Number from the TL Form: 803704
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Department Acceptance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 09/15/2022
Date that the sample was received by the laboratory/organization performing the testing: 11/01/2022
The quantity of what the sample constitutes: 1 qt jug
A brief description of the sample: PMCRS 2-H
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pacific Northwest Oil
