Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993184 DEA: 040A7724 EFIS: 0420000288 COOP: 042763
QA Service Level: 1
DIST-CO-RTE-PM: 04-ALA-80-6.4/6.8
Work Description: Excavation, HMA, structural concrete, minor concrete and drainage.
Location Description: IN BERKELEY AND ALBANY FROM 0.6 MILE NORTH OF UNIVERSITY AVENUE OVERCROSSING TO 0.3 MILE SOUTH OF EL CERRITO SEPARATION AND OVERHEAD
Contractor Name: OC Jones (Will Dieterich)
Contractor Address: 1520 Fourth Street, Berkeley, CA 94710
Resident Engineer: Maxime Dabilly Structure Rep.: Eric Urementa
DIME Sample ID: 2023-06-06-108
TL Number from the TL Form:
Sample Submitted By Organization: CT D04 - Richmond Field Laboratory
Sample Organization Contact: (510) 231-7151
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 06/06/2023
Date that the sample was received by the laboratory/organization performing the testing: 06/06/2023
The quantity of what the sample constitutes: LOT 1 SUBLOT 1
A brief description of the sample: 3/4-INCH RHMA-G
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Vallejo Batch Plant
