Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214680 DEA: 030F2854 EFIS: 0319000205
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-99-7.1/9.4
Work Description: Construct the temporary bridge superstructures, adjacent paving and pave temporary alignment
Location Description:
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 4001 Bradshaw Road, Sacramento, CA 95827
Resident Engineer: Masoud Saed Structure Rep.: Chau Ha
DIME Sample ID: 2022-08-06-16
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Hot Mix Asphalt Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Informational
Type of Material: Hot Mix Asphalt
Sample Taken Date: 08/06/2022
Date that the sample was received by the laboratory/organization performing the testing: 08/06/2022
The quantity of what the sample constitutes: 24 boxes
A brief description of the sample: 3/4" HMA-A
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Construction - Bradshaw