Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213551 DEA: 080K2934 EFIS: 0812000100
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-10-R36.8/R39.2
Work Description: PAVEMENT REHABILITATION AND CONTINUOUSLY REINFORCED CONCRETE PAVEMENT
Location Description: SAN BERNARDINO COUNTY IN YUCAIPA FROM 0.2 MILE WEST OF LIVE OAK CANYON ROAD TO COUNTY LINE ROAD UNDERCROSSING
Contractor Name: Coffman Specialties
Contractor Address: 9685 Via Excelencia, San Diego, CA 92126
Resident Engineer: Ezz Gayed Structure Rep.: Unknown
DIME Sample ID: 2019-05-30-7
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Per Request
Type of Material: Soil
Sample Taken Date: 05/30/2019
Date that the sample was received by the laboratory/organization performing the testing: 05/30/2019
The quantity of what the sample constitutes: 4 Bags
A brief description of the sample: Class 2 Aggregate Base
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Caltrans
The fabricator's/manufacturer's product name for the sample: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: I-10
Where the material sample would have been placed if not sampled: Unknown
