Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994561 DEA: 032G8604 EFIS: 0322000250
QA Service Level: 1
DIST-CO-RTE-PM: 03-PLA-80-R19.0/24.5
Work Description: RHMA, COLD PLANE AC PVMT, & MODIFYING TRAFFIC MONITORING STATIONS.
Location Description: PLACER COUNTY 0.6 MILE EAST OF AUBURN FROM 0.1 MILE EAST OF RUSSELL ROAD OVERCROSSING TO 1.1 MILES EAST OF PLACER HILLS OVERCROSSING
Contractor Name: GEORGE REED, INC.
Contractor Address: 2520 Warren Dr Rocklin CA 95677
Resident Engineer: Justing Kunert Structure Rep.: Unknown
DIME Sample ID: 2023-07-20-26
TL Number from the TL Form:
Sample Submitted By Organization: CT D03 - Rocklin Construction Field Office
Sample Organization Contact: 530-330-2727
Type of Sample: Department Acceptance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 07/20/2023
Date that the sample was received by the laboratory/organization performing the testing: 07/21/2023
The quantity of what the sample constitutes: 280 tons
A brief description of the sample: SS-1H ASPHALTIC EMULSION
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pacific Northwest Oil
