Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000084 DEA: 101R5604 EFIS: 1023000177
QA Service Level: 1
DIST-CO-RTE-PM: 10-CAL,SJ-5,26,99-Var
Work Description: INSTALL HIGH FRICTION SURFACE TREATMENT AND REPLACE DELINEATION.
Location Description: CALAVERAS AND SAN JOAQUIN COUNTIES AT VARIOUS LOCATIONS
Contractor Name: Q&D CONSTRUCTION LLC
Contractor Address: 1050 S 21st STREET, SPARKS, NV 89431
Resident Engineer: Troy Scheiber Structure Rep.: Unknown
DIME Sample ID: 2024-08-20-7
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3665 - Stockton
Sample Organization Contact: (916) 416-7793
Type of Sample: Acceptance
Type of Material: High Friction Surface Treatment
Sample Taken Date: 08/20/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/20/2024
The quantity of what the sample constitutes: 2626 SQYD
A brief description of the sample: HFST
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 29-0309G
Structure name: N99-W4 Connector Undercrossing
The fabricator/manufacturer/facility name: FasTrac Construction Products
