Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993424 DEA: 04281204 EFIS: 0400000769
QA Service Level: 1
DIST-CO-RTE-PM: 04-NAP-29,221-5.5/6.7,0.0/0.2
Work Description: HMA, RDWY EXCAVATION, STRUCTURAL CONC AND MODIFYING LIGHTING SYSTEMS.
Location Description: NAPA COUNTY NEAR NAPA ON ROUTE 29 FROM 0.7 MILE SOUTH TO 0.5 MILE NORTH OF ROUTE 221 AND ON ROUTE 221 FROM 0.2 MILE NORTH OF ROUTE 29 TO ROUTE 29
Contractor Name: Ghilloti Construction Co.
Contractor Address: 246 Ghilloti Ave, Santa Rosa CA 95407
Resident Engineer: Darren Isada Structure Rep.: Unknown
DIME Sample ID: 2024-03-20-40
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: Soil
Sample Taken Date: 03/20/2024
Date that the sample was received by the laboratory/organization performing the testing: 03/20/2024
The quantity of what the sample constitutes: 2550 g
A brief description of the sample: Soil for structure backfill.
From where was the sample collected: Job Site
Laboratory sample identification: Con_24_104
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Native
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: STA 116+55 to STA 116+80
Where the material sample would have been placed if not sampled:
