Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213477 DEA: 080H4704 EFIS: 0812000074
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-2-2.44
Work Description: WIDEN BRIDGE TO ACCOMMODATE STANDARD SHOULDERS
Location Description: AT WRIGHTWOOD AT SHEEP CREEK BRIDGE
Contractor Name: BEADOR CONSTRUCTION
Contractor Address: 26320 LESTER CIRCLE, CORONA, CA 92883
Resident Engineer: John Santos Structure Rep.: Md Rahman
DIME Sample ID: 2019-03-27-3
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: Control Sample
Type of Material: Paint
Sample Taken Date: 03/27/2019
Date that the sample was received by the laboratory/organization performing the testing: 03/27/2019
The quantity of what the sample constitutes: 4
A brief description of the sample: Rocker Bearing Coating
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Sheep Creek Bridge
