Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213248 DEA: 042K0104 EFIS: 0416000341
QA Service Level: 1
DIST-CO-RTE-PM: 04-ALA-24,80,580,880,980-VAR
Work Description: PATCH SPALLS AND REPAIR AC APPROACH.
Location Description: ALAMEDA COUNTY AT VARIOUS LOCATION
Contractor Name: Golden State Bridge
Contractor Address: 3701 Mallard Drive, Benicia, CA 94510
Resident Engineer: Mian Arshad Structure Rep.: Unknown
DIME Sample ID: 2018-08-15-9
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: 08/15/2018
Date that the sample was received by the laboratory/organization performing the testing: 08/15/2018
The quantity of what the sample constitutes: 36 Totes
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
