Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000158 DEA: 033G0304 EFIS: 0323000117
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-160-L1.4/L7.0
Work Description: COLD PLANE AC PVMT, HMA, & RHMA.
Location Description: SACRAMENTO COUNTY NEAR ANTIOCH FROM 0.1 MILE NORTH OF ANTIOCH BRIDGE TO SHERMAN ISLAND EAST LEVEE ROAD
Contractor Name: ALL-AMERICAN CONSTRUCTION, INC.
Contractor Address: 1700 Acacia Avenue, Sutter, CA 95982
Resident Engineer: Mohssen Ghassemi Structure Rep.: Unknown
DIME Sample ID: 2024-08-28-50
TL Number from the TL Form: C849412
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Acceptance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 08/28/2024
Date that the sample was received by the laboratory/organization performing the testing: 09/03/2024
The quantity of what the sample constitutes: 1 jar
A brief description of the sample: ss-1h emulsion TACK OIL
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Unknown
