Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994820 DEA: 060V1104 EFIS: 0616000208
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE,KIN-5,41,198-Var
Work Description: STRATFORD KINGS RIVER BRIDGE REPLACEMENT.
Location Description: FRESNO AND KINGS COUNTIES AT VARIOUS LOCATIONS
Contractor Name: M.C.M. Construction, INC. (Richard McCall)
Contractor Address: 6413 32nd Street, North Highlands, Ca 95660
Resident Engineer: Din Dadawalla Structure Rep.: Martin Garcia
DIME Sample ID: 2024-06-27-45
TL Number from the TL Form: None provided
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Acceptance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 06/27/2024
Date that the sample was received by the laboratory/organization performing the testing: 07/01/2024
The quantity of what the sample constitutes: 1 bottle of emulsion
A brief description of the sample: NO TEST, CSS-1H 50/50
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: American Payment Systems
