Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994642 DEA: 033H7304 EFIS: 0318000055
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-51-5.6/5.9
Work Description: HMA, CLASS 2 AB, RDWY EXC, RCP AND CONCRETE BARRIER.
Location Description: SACRAMENTO COUNTY IN SACRAMENTO FROM 0.1 MILE NORTH OF MARCONI AVENUE TO HOWE AVENUE
Contractor Name: MARTIN BROTHERS CONSTRUCTION
Contractor Address: 9796 Kent St. Elk Grove, CA 95624, Elk Grove, CA 95624
Resident Engineer: Jony Tji Structure Rep.: Elaine Yip
DIME Sample ID: 2024-05-15-38
TL Number from the TL Form:
Sample Submitted By Organization: Blackburn Consulting
Sample Organization Contact: (916) 375-8706
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 05/15/2024
Date that the sample was received by the laboratory/organization performing the testing: 05/15/2024
The quantity of what the sample constitutes: 750 Tons
A brief description of the sample: 3/4" HMA
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Bradshaw Plant
