Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995518 DEA: 101P7104 EFIS: 1022000155
QA Service Level: 1
DIST-CO-RTE-PM: 10-SJ-4,5-Var
Work Description: BRIDGE POLYESTER CONCRETE OVERLAY.
Location Description: SAN JOAQUIN COUNTY AT VARIOUS LOCATIONS
Contractor Name: MCCUEN CONSTRUCTION, INC.
Contractor Address: 3269 Swetzer Road, Loomis, CA,95690
Resident Engineer: Mohamed Taleb Structure Rep.: Daniel Laureno
DIME Sample ID: 2024-05-16-11
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Concrete Testing Laboratory
Sample Organization Contact: (916) 206-4373
Type of Sample: Department Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 05/16/2024
Date that the sample was received by the laboratory/organization performing the testing: 05/17/2024
The quantity of what the sample constitutes: 144 SQFT
A brief description of the sample: POLY BRIDGE DECK
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 29-0237R
Structure name: Mormon Slough
The fabricator/manufacturer/facility name: McCuen Construction
Pavement Surface Type: Polyester Concrete
Type of Traffic Control Provided: Stationary Lane Closure
DIST-CO-RTE: 10-SJ-4,5-Var
Direction of Travel: East
Post Mile: 16.20
Lanes to be Tested: Lane #4
Station:
