Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000005 DEA: 051Q1804 EFIS: 0522000179
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB,SLO-1,101,166,246-Var
Work Description: BRIDGE DECK SEALS, POLYESTER CONCRETE OVERLAYS, & REPLACE JOINT SEALS.
Location Description: SANTA BARBARA AND SAN LUIS OBISPO COUNTIES AT VARIOUS LOCATIONS
Contractor Name: TRUESDELL CORPORATION OF CALIFORNIA, INC.
Contractor Address: 1301 West 23rd Street, Tempe, AZ 85282
Resident Engineer: Philip Gaston Structure Rep.: Sal Heredia
DIME Sample ID: 2024-06-19-13
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - FFS - Skid Testing
Sample Organization Contact: (916) 227-7287
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 06/19/2024
Date that the sample was received by the laboratory/organization performing the testing: 06/19/2024
The quantity of what the sample constitutes: BRIDGE DECK TRIAL SLAB
A brief description of the sample: TRIAL SLAB
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: JOB SITE
