Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994593 DEA: 081M1804 EFIS: 0821000087
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-10,74,79,86,111,243-Var
Work Description: POLYESTER CONCRETE AND HOT MIX ASPHALT OVERLAY.
Location Description: RIVERSIDE COUNTY AT VARIOUS LOCATIONS
Contractor Name: TRUESDELL CORPORATION OF CALIFORNIA, INC.
Contractor Address: Unknown
Resident Engineer: Md Rahman Structure Rep.: Unknown
DIME Sample ID: 2024-03-23-1
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Corona-Stellar Structures Construction Field Office
Sample Organization Contact: 951-906-9897
Type of Sample: Department Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 03/23/2024
Date that the sample was received by the laboratory/organization performing the testing: 03/23/2024
The quantity of what the sample constitutes: Multiple Lanes
A brief description of the sample: Skid Testing Request
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 56-0759R
Structure name: Wasteway No. 2
The fabricator/manufacturer/facility name: Kwik Bond Polymers
Pavement Surface Type: Polyester Concrete
Type of Traffic Control Provided: Stationary Lane Closure
DIST-CO-RTE: 08-Riv-Rte 86
Direction of Travel: North
Post Mile: 18.77
Lanes to be Tested: Lane #1
Station:
