Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994368 DEA: 040K7804 EFIS: 0416000138
QA Service Level: 1
DIST-CO-RTE-PM: 04-SM-84-21.5/25.7
Work Description: REPLACE AC SURFACING, UPGRADE CURB RAMPS, REPLACE MBGR WITH MGS.
Location Description: SAN MATEO COUNTY IN WOODSIDE AND REDWOOD CITY ON ROUTE 84 FROM ROUTE 280 TO ROUTE 101
Contractor Name: GHILOTTI BROS., INC.
Contractor Address: 525 Jacoby Street, San Rafael, CA 94901
Resident Engineer: Mohamed Fouad Structure Rep.: Unknown
DIME Sample ID: 2024-07-29-64
TL Number from the TL Form:
Sample Submitted By Organization: CT D04 - Hayward Field Laboratory
Sample Organization Contact: (510) 723-0168
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 07/29/2024
Date that the sample was received by the laboratory/organization performing the testing: 07/30/2024
The quantity of what the sample constitutes: 0-750 Tons
A brief description of the sample: 3/4" RHMA-G
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: DeSilva Gates Sunol Plant
