Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
DEA: No Project
QA Service Level:
DIST-CO-RTE-PM: ---
Work Description: Special project identifier for material not associated with a project
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2019-05-31-9
TL Number from the TL Form: 908925
Sample Submitted By Organization: CT D01 - District 1 Materials Laboratory
Sample Organization Contact: (707) 496-0974
Type of Sample: Verification
Type of Material: Hot Mix Asphalt
Sample Taken Date: 05/31/2019
Date that the sample was received by the laboratory/organization performing the testing: 05/31/2019
The quantity of what the sample constitutes: JMF Verification
A brief description of the sample: 1/2" HMA PG 64-16
From where was the sample collected: Manufacturer
Laboratory sample identification: 19-076
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kernen
