Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994794 DEA: 051N9304 EFIS: 0521000147
QA Service Level: 1
DIST-CO-RTE-PM: 05-MON-1,101,156-Various
Work Description: Polyester concrete overlay, deck seal, and install sign.
Location Description: MONTEREY, SAN BENITO AND SANTA CRUZ COUNTIES AT VARIOUS LOCATIONS
Contractor Name: TRUESDELL CORP OF CALIFORNIA INC
Contractor Address: 1310 W 23RD STREET, TEMPE AZ 85282
Resident Engineer: Nash Munes Structure Rep.: Unknown
DIME Sample ID: 2023-09-11-5
TL Number from the TL Form:
Sample Submitted By Organization: Sika Corporation
Sample Organization Contact: (562) 941-0231
Type of Sample: Per Request
Type of Material: Rapid Set
Sample Taken Date: 09/11/2023
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 1800 bags
A brief description of the sample: Rapid Setting Mortar
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Sika - Riverside
