Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995123 DEA: 051K4304 EFIS: 0518000207
QA Service Level: 1
DIST-CO-RTE-PM: 05-MON-183-R2.1/R8.3
Work Description: RHMA (GAP GRADED), CONCRETE BARRIER TRANSITION AND LIGHTING SYSTEMS.
Location Description: MONTEREY COUNTY NEAR SALINAS FROM 0.2 MILE SOUTH OF OLD CEMETERY ROAD TO 0.1 MILE SOUTH OF DEL MONTE AVENUE IN CASTROVILLE.
Contractor Name: A. TEICHERT & SON, INC. DBA TEICHERT CONSTRUCTION
Contractor Address: Unknown
Resident Engineer: David Hopper Structure Rep.: Unknown
DIME Sample ID: 2024-08-07-63
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Monterey Construction Field Laboratory
Sample Organization Contact: 831-818-0254
Type of Sample: Acceptance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 08/07/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/09/2024
The quantity of what the sample constitutes: 08/07/2024
A brief description of the sample: 1 Qt of SS1 H Tack Coat
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: VSS Emultech
