Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213459 DEA: 101E5904 EFIS: 1017000014
QA Service Level: 1
DIST-CO-RTE-PM: 10-SJ,STA,TUO-4,5,99,120,205-Various
Work Description: PLACE HIGH FRICTION SURFACE TREATMENT.
Location Description: SAN JOAQUIN,STANISLAUS AND TUOLUMNE COUNTIES AT VARIOUS LOCATIONS.
Contractor Name: AMERICAN CIVIL CONSTRUCTORS WEST COAST LLC
Contractor Address: 2990 Bay Vista Court, Benicia, CA 94510
Resident Engineer: Ranbir Bhullar Structure Rep.: Daniel Laureno
DIME Sample ID: 2019-07-01-9
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: 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: 2 tankers
A brief description of the sample: 1 gallon can
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kwik bond and Reichhold
