Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212577 DEA: 11408704 EFIS: 1112000017
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-8-9.0/15.3
Work Description: SLAB REPLACEMENT, COLD PLANE, GRIND PAVEMENT AND REPLACE GUARDRAIL.
Location Description: SAN DIEGO COUNTY FROM 0.6 MILE WEST OF LAKE MURRAY BOULEVARD OVERCROSSING IN SAN DIEGO TO JOHNSON AVENUE UNDERCROSSING IN EL CAJON
Contractor Name: FLATIRON WEST, INC.
Contractor Address: 1770 La Costa Meadows Drive, San Marcos, CA 92078
Resident Engineer: John Williamson Structure Rep.: Unknown
DIME Sample ID: 2018-07-17-2
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Sample Organization Contact: (858) 285-5797
Type of Sample: Quality Assurance
Type of Material: Thermoplastic
Sample Taken Date: 07/17/2018
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 20
A brief description of the sample: Single sheet aluminum sign panel
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Material sign
