Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994812 DEA: 042K7204 EFIS: 0417000014
QA Service Level: 1
DIST-CO-RTE-PM: 04-CC-4-R14.3/24.3
Work Description: Pvmt rehabilitation, slab repl, ADA curb ramp and install guardrail.
Location Description: On state highway in Contra Costa County in and near Concord and Pittsburg from 0.3 miles east of Peralta Road Undercrossing to Loveridge Road Overcrossing.
Contractor Name: O.C. Jones & Sons, Inc. (Victor Babbitt)
Contractor Address: 1520 Fourth Street, Berkeley, CA 94710
Resident Engineer: Rabi Mukherjee Structure Rep.: Unknown
DIME Sample ID: 2023-10-17-65
TL Number from the TL Form:
Sample Submitted By Organization: CT D04 - Concord Field Laboratory
Sample Organization Contact: (510) 714-7019
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 10/17/2023
Date that the sample was received by the laboratory/organization performing the testing: 10/24/2023
The quantity of what the sample constitutes: L 2 SL 4
A brief description of the sample: 3/4-INCH RHMA-G
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Vernalis Drier Dum Plant
