Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215336 DEA: 051G9804 EFIS: 0516000009
QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO-1-10.0/16.8
Work Description: RHMA (GAP GRADED), RETAINING WALL, CURB RAMPS AND LIGHTING SYSTEMS.
Location Description: SAN LUIS OBISPO COUNTY FROM GRACIA WAY AT OCEANO TO ROUTE 1/101 SEPARATION IN PISMO BEACH.
Contractor Name: CALPORTLAND CONSTRUCTION
Contractor Address: 1625 E DONOVAN RD, SANTA MARIA, CA 93454
Resident Engineer: ALBERT REED Structure Rep.: Sal Heredia
DIME Sample ID: 2023-09-20-72
TL Number from the TL Form: C230920A
Sample Submitted By Organization: CT D05 - Santa Maria Field Laboratory
Sample Organization Contact: 8053191237
Type of Sample: Department Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 09/20/2023
Date that the sample was received by the laboratory/organization performing the testing: 09/21/2023
The quantity of what the sample constitutes: Up to 750 Tons
A brief description of the sample: 3/4" coldfeed
From where was the sample collected: Supplier
Laboratory sample identification: 230920A
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Calportland-Garey
