Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000091 DEA: 032G5404 EFIS: 0321000237
QA Service Level: 1
DIST-CO-RTE-PM: 03-YOL-128,505-VAR
Work Description: PLACE AND FURNISH POLYESTER CONCRETE OVERLAY, & REPLACE JOINT SEALS.
Location Description: YOLO COUNTY AT VARIOUS LOCATIONS
Contractor Name: BRIDGEWAY CIVIL CONSTRUCTORS, INC.
Contractor Address: 3333 Vaca Valley Parkway, Suite 2000, Vacaville, CA 95688
Resident Engineer: Nimi Badwalz Structure Rep.: Brent Bullard
DIME Sample ID: 2024-10-14-5
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - FFS - Skid Testing
Sample Organization Contact: (916) 227-7287
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 10/14/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/14/2024
The quantity of what the sample constitutes: PCC
A brief description of the sample: PCC
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: JOB SITE
Pavement Surface Type: PCC (Portland Cement Concrete)
Type of Traffic Control Provided: Moving Lane Closure
DIST-CO-RTE:
Direction of Travel:
Post Mile:
Lanes to be Tested:
Station:
