Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000142 DEA: 033G0604 EFIS: 0323000120
QA Service Level: 1
DIST-CO-RTE-PM: 03-YOL-45-0.2/12.9
Work Description: COLD PLANE AC PAVEMENT, HMA AND SEAL COAT.
Location Description: YOLO COUNTY NEAR KNIGHTS LANDING FROM SYCAMORE SLOUGH BRIDGE TO COUNTY LINE ROAD
Contractor Name: TALLEY OIL, INC.
Contractor Address: 12483 Road 29, Madera ,CA 93638
Resident Engineer: Luis Pompa Structure Rep.: Unknown
DIME Sample ID: 2024-08-06-43
TL Number from the TL Form: C042947
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: 08/06/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/07/2024
The quantity of what the sample constitutes: No test
A brief description of the sample: Emulsion - PMCRS-2h
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: TALLY OIL INC
