Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993662 DEA: 061A6404 EFIS: 0620000176
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-41,180-R23.1,R58.7
Work Description: PLACE POLYESTER CONCRETE OVERLAY AND REPLACE JOINT SEAL ASSEMBLY.
Location Description: FRESNO COUNTY IN FRESNO ON ROUTE 41 AT VENTURA AVENUE VIADUCT AND ON ROUTE 180 AT ROUTE 180/41 CONNECTOR SEPARATION
Contractor Name: TPA CONSTRUCTION INC.
Contractor Address: 2406 Clubhouse Dr., Rocklin, CA 95765
Resident Engineer: Fernando De Alba Structure Rep.: Ramandeep Guraya
DIME Sample ID: 2023-08-25-57
TL Number from the TL Form:
Sample Submitted By Organization: T.P.A Construction Incorporated
Sample Organization Contact: (916) 320-7600
Type of Sample: Informational
Type of Material: Rapid Set
Sample Taken Date: 08/25/2023
Date that the sample was received by the laboratory/organization performing the testing: 08/25/2023
The quantity of what the sample constitutes: 1 bag
A brief description of the sample: CTS Rapid Set Cement
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CTS Inc
