Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214093 DEA: 081J1504 EFIS: 0817000213
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-215-4.2/17.3
Work Description: TREAT BRIDGE DECK AND PLACE POLYESTER CONCRETE OVERLAY.
Location Description: SAN BERNARDINO COUNTY IN AND NEAR COLTON AND SAN BERNARDINO AT VARIOUS LOCATIONS FROM SANTA ANA RIVER BRIDGE TO DEVORE ROAD OVERCROSSING
Contractor Name: PETERSON-CHASE GENERAL ENGINEERING CONSTRUCTION, INC.
Contractor Address: 16351 Construction Circle West, Irvine, CA 92606-4414
Resident Engineer: Kee Ooi Structure Rep.: Unknown
DIME Sample ID: 2019-07-01-1
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: Methacrylate
Sample Taken Date: 07/01/2019
Date that the sample was received by the laboratory/organization performing the testing: 07/01/2019
The quantity of what the sample constitutes: 25000 gallons
A brief description of the sample: 2 pints 204,chp,zcure,8020
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: kwik Bond, Benecia
