Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994975 DEA: 034H0704 EFIS: 0318000158
QA Service Level: 1
DIST-CO-RTE-PM: 03-NEV-20-R12.2/20.0
Work Description: COLD PLANE AND OVERLAY, INSTALL CURED-IN-PLACE PIPELINERS.
Location Description: NEVADA COUNTY IN AND NEAR GRASS VALLEY AND NEVADA CITY FROM ROUTE 20/49 SEPARATION TO 0.1 MILE EAST OF CELIO ROAD
Contractor Name: DESILVA GATES CONSTRUCTION LLC
Contractor Address: 3855 N Freeway, Ste. 100, Sacramento, CA 95834
Resident Engineer: Renee Plaza Structure Rep.: Unknown
DIME Sample ID: 2024-06-23-26
TL Number from the TL Form:
Sample Submitted By Organization: CT D03 - Olivehurst Northern Regional Laboratory
Sample Organization Contact: (530) 741-4238
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 06/23/2024
Date that the sample was received by the laboratory/organization performing the testing: 07/01/2024
The quantity of what the sample constitutes: Boxes of Mix
A brief description of the sample: 3/4" RHMA-G
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Hallwood
