Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000239 DEA: 030L2704 EFIS: 0324000076
QA Service Level: 1
DIST-CO-RTE-PM: 03---
Work Description: Rutting Repair
Location Description:
Contractor Name: Q & D CONSTRUCTION, INC
Contractor Address: 1050 S 21st STREET, SPARKS, NV 89431
Resident Engineer: Reza Salehi Structure Rep.: Unknown
DIME Sample ID: 2024-04-05-31
TL Number from the TL Form: Sacramento Caltrans lab
Sample Submitted By Organization: Kwik Bond Polymers
Sample Organization Contact: (760) 518-6064
Type of Sample: Quality Control
Type of Material: Polyester
Sample Taken Date: 04/05/2024
Date that the sample was received by the laboratory/organization performing the testing: 04/08/2024
The quantity of what the sample constitutes: 36 Totes
A brief description of the sample: 1 gallon can / 9800 RESIN
From where was the sample collected: Source
Laboratory sample identification: 000053KBP
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kwik Bond Polymers, Benicia
