Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212246 DEA: 053307A4 EFIS: 0514000027
QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO-46-49.7/54.6
Work Description: Cholame Segment
Location Description:
Contractor Name: Atkinson Construction
Contractor Address: 18201 Von Karman - Suite 800, Irvine, CA 92612
Resident Engineer: Andrew Borrelli Structure Rep.: Dave Lewis
DIME Sample ID: 2024-08-13-114
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Whitley Gardens Field Laboratory
Sample Organization Contact: 805-540-9933
Type of Sample: Dispute Resolution
Type of Material: Antistrip Additive
Sample Taken Date: 08/13/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/12/2024
The quantity of what the sample constitutes: 750 tons
A brief description of the sample: L221154 Liquid Antistrip
From where was the sample collected: Source
Laboratory sample identification: 240813 L1 SL52
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Sierra Pacific Materials - Avenal
