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Sample Record for 2018-07-19-15

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 213210 DEA: 010G3604 EFIS: 0116000174 QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN,HUM-101-VAR
Work Description: PLACE POLYESTER CONCRETE OVERLAY & METHACRYLATE DECK.
Location Description: HUMBOLDT AND MENDOCINO COUNTIES AT VARIOUS LOCATIONS
Contractor Name: Truesdell Corporation of California
Contractor Address: 1310 W. 23rd Street, Tempe, AZ 85282
Resident Engineer: Robert King Structure Rep.: Peter J O'Donnell

Sample Information

DIME Sample ID: 2018-07-19-15
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: 07/19/2018
Date that the sample was received by the laboratory/organization performing the testing: 07/19/2018
The quantity of what the sample constitutes: 1 tanker
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

Material Information

Mfg. Lot Number(s): 1131616
Batch number: 1131616
Mix number: 1131616

Test Results