Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994949 DEA: 043Q5504 EFIS: 0419000223
QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN-37,101,131-VAR
Work Description: PLACE POLYESTER CONCRETE OVERLAY AND CONSTRUCT APPROACH SLABS.
Location Description: MARIN COUNTY AT VARIOUS LOCATIONS
Contractor Name: American Civil Constructors West Coast LLC (Kaitlyn Howisey)
Contractor Address: 2990 Bay Vista Court, Benicia, CA 94510-1246
Resident Engineer: Dawit Habteselassie Structure Rep.: Cliff Law
DIME Sample ID: 2023-12-04-38
TL Number from the TL Form:
Sample Submitted By Organization: CT D04 - Richmond Field Laboratory
Sample Organization Contact: (510) 231-7151
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 12/04/2023
Date that the sample was received by the laboratory/organization performing the testing: 12/13/2023
The quantity of what the sample constitutes: Sample 1 of the day
A brief description of the sample: 1/2-INCH HMA-SP Type A
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Rock Redwood City
