Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 211902 DEA: 030G3404 EFIS: 0315000084
QA Service Level: 1
DIST-CO-RTE-PM: 03-NEV-80-R12.3/21.2
Work Description: COLD PLANE AND PLACE POLYESTER CONCRETE INLAY AND HOT MIX ASPHALT
Location Description: NEVADA COUNTY IN AND NEAR TRUCKEE FROM 0.3 MILE WEST OF DONNER PARK OVERCROSSING TO TRUCKEE RIVER BRIDGE 17-0012
Contractor Name: Q & D CONSTRUCTION, INC
Contractor Address: 1050 S 21st STREET, SPARKS, NV 89431
Resident Engineer: Tim Crosby Structure Rep.: Unknown
DIME Sample ID: 2017-08-04-3
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: Polyester
Sample Taken Date: 08/04/2017
Date that the sample was received by the laboratory/organization performing the testing: 08/04/2017
The quantity of what the sample constitutes: 2 tankers
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
