Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 209732 DEA: 072881U4 EFIS: 0714000085
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-210-R16.1/R25.8
Work Description: CONSTRUCT CONCRETE PAVEMENT, PRECAST CONCRETE PANELS, AND SLABS.
Location Description: LOS ANGELES COUNTY IN LA CANADA FLINTRIDGE, GLENDALE AND PASADENA FROM DUNSMORE AVENUE UNDERCROSSING TO NORTH LOS ROBLES AVENUE OVERCROSSING
Contractor Name: FLATIRON WEST, INC.
Contractor Address: 1770 LA COSTA MEADOWS DRIVE, SAN MARCOS, CA 92078
Resident Engineer: Sushil Chaudhari Structure Rep.: Mark Amorsolo
DIME Sample ID: 2016-06-10-13
TL Number from the TL Form: c240499
Sample Submitted By Organization: CT HQ - Sacramento Concrete Testing Laboratory
Sample Organization Contact: (916) 594-1991
Type of Sample: Quality Assurance
Type of Material: Polyester
Sample Taken Date: 06/10/2016
Date that the sample was received by the laboratory/organization performing the testing: 06/14/2016
The quantity of what the sample constitutes: 2 tankers
A brief description of the sample: 1 gallon can
From where was the sample collected: Manufacturer
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: reichhold azusa
