Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000008 DEA: 061F8404 EFIS: 0623000102
QA Service Level: 1
DIST-CO-RTE-PM: 06-KER-33-R60.2/73.7
Work Description: COLD PLANE WITH HOT MIX ASPHALT AND RUBBERIZED HOT MIX ASPHALT.
Location Description: KERN COUNTY FROM ROUTE 46 TO KINGS COUNTY LINE
Contractor Name: PAPICH CONSTRUCTION COMPANY, INC.
Contractor Address: 398 SUNRISE TERRACE;, ARROYO GRANDE CA 93420
Resident Engineer: Jake Garcia Structure Rep.: Unknown
DIME Sample ID: 2024-07-16-63
TL Number from the TL Form:
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: 07/16/2024
Date that the sample was received by the laboratory/organization performing the testing: 07/19/2024
The quantity of what the sample constitutes: 2 CANS OF BWC
A brief description of the sample: BWC
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: WESTERN EMULSION
