Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994788 DEA: 0600INF4 EFIS: 0622000064
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE,FRE/FRE-33,99-44.4/46.8
Work Description:
Location Description:
Contractor Name: Cal Valley Construction
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2023-08-10-24
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Millbrook Field Laboratory
Sample Organization Contact: (559) 417-5341
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 08/10/2023
Date that the sample was received by the laboratory/organization performing the testing: 08/10/2023
The quantity of what the sample constitutes: 992
A brief description of the sample: 1/2 Hot Mix Asphalt w/15%Rap
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Ashlan
