Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 210097 DEA: 100L9704 EFIS: 1012000053
QA Service Level: 1
DIST-CO-RTE-PM: 10-TUO-120-R19.5/R20.0
Work Description: REPLACE DECK AND RETROFIT BRIDGE.
Location Description: IN TUOLUMNE COUNTY ON STATE ROUTE 120 FROM 7.6 MILES EAST OF YOSEMITEJUNCTION TO 4.8 MILES WEST OF THE TOWN OF MOCCASIN AT TUOLUMNE RIVER/DON PEDRO RESERVOIR (JAMES E.
Contractor Name: Golden State Bridge
Contractor Address: 3701 Mallard Drive, Benicia, CA 94510
Resident Engineer: Corey Casey Structure Rep.: Ehab Wahed
DIME Sample ID: 2017-10-05-2
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: 10/05/2017
Date that the sample was received by the laboratory/organization performing the testing: 10/05/2017
The quantity of what the sample constitutes: 8 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
