Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995051 DEA: 023H6804 EFIS: 0218000006
QA Service Level: 1
DIST-CO-RTE-PM: 02-SHA-5-R28.8/R44.1
Work Description: PLACE RHMA, PAINT TRAFFIC STRIPE, & INSTALL FIBER OPTIC CABLE SYSTEM.
Location Description: SHASTA COUNTY ABOUT 6 MILES NORTH OF SHASTA LAKE CITY FROM PIT RIVER BRIDGE TO 1.2 MILES SOUTH OF DOG CREEK BRIDGE
Contractor Name: J.F. SHEA CONSTRUCTION, INC.
Contractor Address: 17400 CLEAR CREEK ROAD, REDDING, CA 96001
Resident Engineer: Kyle Higgins Structure Rep.: Unknown
DIME Sample ID: 2024-07-22-95
TL Number from the TL Form: 853417
Sample Submitted By Organization: CT D02 - Redding Northern Regional Laboratory
Sample Organization Contact: (530) 225-3194
Type of Sample: Verification
Type of Material: Hot Mix Asphalt
Sample Taken Date: 07/22/2024
Date that the sample was received by the laboratory/organization performing the testing: 07/23/2024
The quantity of what the sample constitutes: 20 k
A brief description of the sample: 8 boxes of Lime Treated 3/4-inch RHMA-G (PG 64-16 CR) virgin PG 64-16 from Valero – Benicia
From where was the sample collected: Manufacturer
Laboratory sample identification: D79653
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: J F Shea Construction Inc - Fawndale Rock and Asphalt - Redding CA
