Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000022 DEA: 051Q4904 EFIS: 0523000037
QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO,SB-166-R30.4/R35.0
Work Description: COLD PLANE AC PAVEMENT AND OVERLAY WITH RHMA-G.
Location Description: SANTA BARBARA AND SAN LUIS OBISPO COUNTIES ABOUT 20 MILES EAST OF SANTA MARIA FROM CUYAMA RIVER BRIDGE TO CUYAMA RIVER BRIDGE.
Contractor Name: GRIFFITH COMPANY
Contractor Address: Unknown
Resident Engineer: Philip Gaston Structure Rep.: Unknown
DIME Sample ID: 2024-08-27-14
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Santa Maria Field Laboratory
Sample Organization Contact: 8053191237
Type of Sample: Quality Assurance
Type of Material: Crumb Rubber Modifier
Sample Taken Date: 08/27/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/27/2024
The quantity of what the sample constitutes: 2 Gallons, 1 Shipment
A brief description of the sample: HI NAT crumb rubber
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CRM
