Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213457 DEA: 11430434 EFIS: 1118000197
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-8-12.9/14.6,14.9
Work Description: HMA, STRUCTURAL BRIDGE, POLYESTER CONC OVERLAY, JPCP, & CONC BARRIER.
Location Description: SAN DIEGO COUNTY IN LA MESA AND EL CAJON FROM 0.1 MILE WEST OF GROSSMONT BOULEVARD OVERCROSSING TO WEST MAIN STREET OVERCROSSING AND AT MARSHALL AVENUE OVERHEAD
Contractor Name: Griffith Company
Contractor Address: 13400 Sabre Springs Parkway, Suite 200, SAN DIEGO, CA 92128
Resident Engineer: Chad Lim Structure Rep.: Janelle Clanton
DIME Sample ID: 2023-12-11-56
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Cement Testing Laboratory
Sample Organization Contact: (916) 227-7071
Type of Sample: Quality Assurance
Type of Material: Cementitious
Sample Taken Date: 12/11/2023
Date that the sample was received by the laboratory/organization performing the testing: 12/11/2023
The quantity of what the sample constitutes: 1 bag
A brief description of the sample: Rapid Setting Cement
From where was the sample collected: Job Site
Laboratory sample identification: CM234301
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CTS