Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994779 DEA: 034J1504 EFIS: 0323000124
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-99-5/8.300000000000001
Work Description:
Location Description:
Contractor Name: Granite Construction Company
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2023-04-29-17
TL Number from the TL Form: TL 875260
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Department Acceptance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 04/29/2023
Date that the sample was received by the laboratory/organization performing the testing: 05/01/2023
The quantity of what the sample constitutes: 1 of 1
A brief description of the sample: tack oil
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: unknown
