Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994513 DEA: 043Y0604 EFIS: 0423000193
QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN-1-var/var
Work Description: PAVEMENT REPAIR
Location Description:
Contractor Name: Team Ghilotti
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2023-04-04-21
TL Number from the TL Form: C727192
Sample Submitted By Organization: CT D04 - Richmond Field Laboratory
Sample Organization Contact: (510) 231-7151
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 04/04/2023
Date that the sample was received by the laboratory/organization performing the testing: 04/05/2023
The quantity of what the sample constitutes: 1 RAP Bag
A brief description of the sample: RAP Aggregates for HMA
From where was the sample collected: Manufacturer
Laboratory sample identification: Rich_23_090
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Vallejo
