Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993639 DEA: 031J0104 EFIS: 0320000059
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC,YOL-99,113-19.7,23.1,R1.1,R2.1
Work Description: CONSTRUCT CURB RAMPS, SIDEWALKS AND MODIFY SIGNAL SYSTEMS.
Location Description: SACRAMENTO AND YOLO COUNTIES AT VARIOUS LOCATIONS
Contractor Name: CALIFORNIA HIGHWAY CONSTRUCTION GROUP, INC.
Contractor Address: 1647 WILLOW PASS RD #150, CONCORD CA 94520
Resident Engineer: Jody Philips Structure Rep.: Unknown
DIME Sample ID: 2023-10-20-20
TL Number from the TL Form:
Sample Submitted By Organization: Blackburn Consulting
Sample Organization Contact: (916) 375-8706
Type of Sample: Quality Control
Type of Material: Hot Mix Asphalt
Sample Taken Date: 10/20/2023
Date that the sample was received by the laboratory/organization performing the testing: 10/24/2023
The quantity of what the sample constitutes: 2 HMA Boxes
A brief description of the sample: 3/4" HMA
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Perkins
