Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214141 DEA: 081J1204 EFIS: 0817000208
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-15,91,215-Var
Work Description: REMOVE, PREPARE AND FURNISH POLYESTER CONCRETE OVERLAY.
Location Description: RIVERSIDE COUNTY AT VARIOUS LOCATIONS
Contractor Name: J. FRANCIS COMPANY
Contractor Address: 16197 Krameria Ave., Riverside, CA 92504
Resident Engineer: Xavier Avila Structure Rep.: Unknown
DIME Sample ID: 2019-08-21-15
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: 08/21/2019
Date that the sample was received by the laboratory/organization performing the testing: 08/21/2019
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: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: kwik Bond, Benecia
