Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213320 DEA: 030G9504 EFIS: 0317000213
QA Service Level: 1
DIST-CO-RTE-PM: 03-NEV-80-VAR
Work Description: REPLACE POLYESTER CONCRETE OVERLAY
Location Description: NEVADA COUNTY AT VARIOUS LOCATIONS
Contractor Name: PETERSON-CHASE GENERAL ENGINEERING CONSTRUCTION, INC.
Contractor Address: 16351 Construction Circle West, Irvine, CA 92606-4414
Resident Engineer: Tim Crosby Structure Rep.: Unknown
DIME Sample ID: 2018-08-18-3
TL Number from the TL Form: 969886
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: 08/18/2018
Date that the sample was received by the laboratory/organization performing the testing: 08/20/2018
The quantity of what the sample constitutes: 2 tankers
A brief description of the sample: polyester resin
From where was the sample collected: Manufacturer
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kwik bond and Reichhold
