Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 211669 DEA: 022C0904 EFIS: 0200000161
QA Service Level: 1
DIST-CO-RTE-PM: 02-PLU-70-50.6/51.7
Work Description: BRIDGE WIDENING AND DECK REPLACEMENT, HMA, MGS AND CULVERT REPLACEMENT
Location Description: PLUMAS COUNTY NEAR QUINCY FROM 0.6 MILE WEST TO 0.5 MILE EAST OF SPRING GARDEN BRIDGE OVERHEAD
Contractor Name: MCM Construction
Contractor Address: 6413 32ND STREET, North Highlands, Ca 95660
Resident Engineer: Ronald Collins Structure Rep.: Jeffrey Rothgery
DIME Sample ID: 2017-03-06-3
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: Methacrylate
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: 2 pints can
A brief description of the sample: 2 qints 204 chp,8020,zcure
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
