Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995063 DEA: 112N1084 EFIS: 1121000057
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-5-6.1,R22.9
Work Description: SPALL REPAIRS, PLACE JOINT SEALS, & PLACE POLYESTER CONCRETE OVERLAY.
Location Description: SAN DIEGO COUNTY ON ROUTE 5 IN CHULA VISTA AT PALOMAR STREET OVERCROSSING AND IN SAN DIEGO AT DE ANZA OFF-RAMP UNDERCROSSING
Contractor Name: TRUESDELL CORPORATION OF CALIFORNIA, INC.
Contractor Address: 1310 W 23RD STREET, TEMPE AZ 85282
Resident Engineer: John Tran Structure Rep.: Unknown
DIME Sample ID: 2024-08-01-29
TL Number from the TL Form:
Sample Submitted By Organization: Sika Corporation
Sample Organization Contact: (562) 941-0231
Type of Sample: Per Request
Type of Material: Rapid Set
Sample Taken Date: 08/01/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/01/2024
The quantity of what the sample constitutes: 6000 bags
A brief description of the sample: Rapid Setting Mortar
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Sika - Riverside
