Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994745 DEA: 040Y2304 EFIS: 0422000258
QA Service Level: 1
DIST-CO-RTE-PM: 04-NAP-29-0.0/5.1
Work Description: Cold plane AC pavement and place HMA (A).
Location Description: CONSTRUCTION ON STATE HIGHWAY IN NAPA COUNTY IN AND NEAR AMERICAN CANYON FROM SOLANO COUNTY LINE TO 0.4 MILE NORTH OF AIRPORT BOULEVARD.
Contractor Name: Ghilotti Bros, Inc. (JR Ramirez, Kaely Verdu, Joe Palesi)
Contractor Address: 525 Jacoby Street, San Rafael, CA 94901
Resident Engineer: Paramdeep Brar Structure Rep.: Unknown
DIME Sample ID: 2023-07-20-69
TL Number from the TL Form: 727276
Sample Submitted By Organization: CT D04 - Concord Field Laboratory
Sample Organization Contact: (510) 714-7019
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
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: LOT 1 SUBLOT 4
A brief description of the sample: 3/4-INCH HMA Types A and B
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Vallejo Batch Plant
