Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994051 DEA: 041Q5814 EFIS: 0421000262
QA Service Level: 1
DIST-CO-RTE-PM: 04-SM-101-0.0-6.5
Work Description: REHABILITATE PAVEMENT AND UPGRADE MEDIAN BARRIER [PS&E E-COPY AVAILABLE UPON REQUEST]
Location Description: SAN MATEO COUNTY FROM SAN MATEO COUNTY LINE IN EAST PALO ALTO TO WHIPPLE AVENUE IN REDWOOD CITY
Contractor Name: BAY CITIES PAVING & GRADING, INC.
Contractor Address: Unknown
Resident Engineer: Ethan Malonzo Structure Rep.: Unknown
DIME Sample ID: 2024-06-30-28
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: 06/30/2024
Date that the sample was received by the laboratory/organization performing the testing: 07/10/2024
The quantity of what the sample constitutes: 0-750 Tons
A brief description of the sample: 1/2" RHMA-G
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Pleasanton
