Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 211588 DEA: 030F3104 EFIS: 0300000078
QA Service Level: 1
DIST-CO-RTE-PM: 03-ED-49-23.6/24.5
Work Description: REPLACE BRIDGE.
Location Description: EL DORADO COUNTY NEAR COLOMA FROM 0.1 MILE EAST OF MARSHALL ROAD TO 0.3 MILE EAST OF LOTUS ROAD
Contractor Name: M.C.M. CONSTRUCTION, INC.
Contractor Address: P.O. Box 620, North Highlands, CA 95660
Resident Engineer: Jeff Hamm Structure Rep.: Glen Wheeler
DIME Sample ID: 2018-04-06-8
TL Number from the TL Form: 790451
Sample Submitted By Organization: CT D03 - Olivehurst Northern Regional Laboratory
Sample Organization Contact: (530) 741-4238
Type of Sample: Verification
Type of Material: Hot Mix Asphalt
Sample Taken Date: 04/06/2018
Date that the sample was received by the laboratory/organization performing the testing: 04/09/2018
The quantity of what the sample constitutes: JMF Verification
A brief description of the sample: JMF Verification
From where was the sample collected: Source
Laboratory sample identification: JMF18-002
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Bradshaw
