Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 211162 DEA: 044G4504 EFIS: 0412000477
QA Service Level: 1
DIST-CO-RTE-PM: 04-SOL-780-7.07
Work Description: REPLACE BRIDGE TO PROVIDE STANDARD VERTICAL CLEARANCE
Location Description: LAUREL STREET OC
Contractor Name: R N R CONSTRUCTION, INC.
Contractor Address: 8589 Thys Court, Sacramento, CA 95828
Resident Engineer: Jolie Schneider Structure Rep.: Joe De La Torre
DIME Sample ID: 2017-08-30-3
TL Number from the TL Form: Unknown
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Quality Assurance
Type of Material: Cementitious
Sample Taken Date: 08/30/2017
Date that the sample was received by the laboratory/organization performing the testing: 09/01/2017
The quantity of what the sample constitutes: 6
A brief description of the sample: grout
From where was the sample collected: Job Site
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RNR Construction
