Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994570 DEA: 040Y2404 EFIS: 0422000259
QA Service Level: 1
DIST-CO-RTE-PM: 04-ALA-92-R2.4/6.8
Work Description: COLD PLANE ASPHALT CONCRETE PAVEMENT AND PLACE HOT MIX ASPHALT.
Location Description: ALAMEDA COUNTY IN HAYWARD FROM 0.2 MILE WEST OF SAN MATEO-HAYWARD TOLL PLAZA TO SANTA CLARA STREET
Contractor Name: O.C. JONES & SONS INC.
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2023-05-19-48
TL Number from the TL Form:
Sample Submitted By Organization: CT D04 - Hayward Field Laboratory
Sample Organization Contact: (510) 723-0168
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 05/19/2023
Date that the sample was received by the laboratory/organization performing the testing: 05/22/2023
The quantity of what the sample constitutes: 132 Tons
A brief description of the sample: 3/4 WHMA-A + 25% RAP
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan-Pleasanton
