Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 211736 DEA: 042A4904 EFIS: 0400000827
QA Service Level: 1
DIST-CO-RTE-PM: 04-SF-280-R4.8/R6.2
Work Description: BRIDGE POLYESTER CONCRETE OVERLAY, DRAINAGE AND BARRIER RECONSTRUCTION
Location Description: THE CITY AND COUNTY OF SAN FRANCISCO AT VARIOUS LOCATIONS FROM 0.5 MILE NORTH OF ROUTE 280/101 SEPARATION TO 0.2 MILE SOUTH OF 20TH STREET OVERCROSSING
Contractor Name: Myers and Sons / RL Wadsworth JV
Contractor Address: 4600 Northgate Blvd, Ste 100, Sacramento, CA 95834
Resident Engineer: Jose David Structure Rep.: Peter Lam
DIME Sample ID: 2017-03-06-2
TL Number from the TL Form: Sacramento Caltrans lab
Sample Submitted By Organization: Kwik Bond Polymers
Sample Organization Contact: (760) 518-6064
Type of Sample: Quality Control
Type of Material: Polyester
Sample Taken Date: 03/06/2017
Date that the sample was received by the laboratory/organization performing the testing: 03/06/2017
The quantity of what the sample constitutes: 80 drums and 16 totes
A brief description of the sample: 1 gallon can
From where was the sample collected: Source
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kwik bond and Reichhold
