Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213590 DEA: 041J3704 EFIS: 0414000250
QA Service Level: 1
DIST-CO-RTE-PM: 04-ALA,CC-13,84,238,580,680,880-Var
Work Description: APPLY HIGH FRICTION SURFACE TREATMENT, REHABILITATE PAVEMENT
Location Description: ALAMEDA AND CONTRA COSTA COUNTIES AT VARIOUS LOCATIONS
Contractor Name: AMERICAN CIVIL CONSTRUCTORS WEST COAST LLC
Contractor Address: 2990 Bay Vista Ct, Benicia, CA 94510
Resident Engineer: Harpal Chahal Structure Rep.: Unknown
DIME Sample ID: 2019-08-12-10
TL Number from the TL Form:
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: 08/12/2019
Date that the sample was received by the laboratory/organization performing the testing: 08/12/2019
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 Polymers and Reichhold
