Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993208 DEA: 034F38U4 EFIS: 0321000092
QA Service Level: 1
DIST-CO-RTE-PM: 03-YUB-70-16.2/25.8
Work Description: WIDEN SHOULDERS AND IMPROVE CLEAR RECOVERY ZONE.
Location Description: YUBA COUNTY NEAR MARYSVILLE FROM 0.2 MILE NORTH OF LAURELLEN ROAD TO SOUTH HONCUT CREEK BRIDGE
Contractor Name: DeSilva Gates
Contractor Address: 11555 Dublin Boulevard, Dublin, CA 94568
Resident Engineer: Manoharan Selvendran Structure Rep.: Unknown
DIME Sample ID: 2023-06-01-92
TL Number from the TL Form:
Sample Submitted By Organization: CT D03 - Chico Field Laboratory
Sample Organization Contact: (916) 799-4305
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 06/01/2023
Date that the sample was received by the laboratory/organization performing the testing: 06/02/2023
The quantity of what the sample constitutes: 12 4X4X8 Boxes
A brief description of the sample: L4S3
From where was the sample collected: Source
Laboratory sample identification: L4S1
Structure unique identifier:
Structure name: Full Depth Repair -Dig Out
The fabricator/manufacturer/facility name: DeSilva Gates - Marysville
