Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213032 DEA: 101G3304 EFIS: 1016000157
QA Service Level: 1
DIST-CO-RTE-PM: 10-MER-5,152-Var
Work Description: REPLACE JOINT SEALS, APPROACH SLABS, POLYESTER CONCRETE OVERLAY.
Location Description: MERCED COUNTY AT VARIOUS LOCATIONS.
Contractor Name: MYERS AND SONS CONSTRUCTION, LP
Contractor Address: 4600 NORTHGATE BLVD. SUITE 10, SACRAMENTO CA 95834
Resident Engineer: Muhammad Rahman Structure Rep.: Sam Singh
DIME Sample ID: 2018-08-27-4
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: 08/27/2018
Date that the sample was received by the laboratory/organization performing the testing: 08/27/2018
The quantity of what the sample constitutes: 2 tankers
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
