Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213945 DEA: 060U1604 EFIS: 0615000310
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-41-R22.0/R22.6
Work Description: FURNISH & PLACE POLYESTER CONCRETE OVERLAY & PLACE JOINT SEAL.
Location Description: FRESNO COUNTY IN FRESNO FROM 0.2 MILE NORTH OF ROUTE 41/99 SEPARATION TO 0.1 MILE SOUTH OF VAN NESS AVENUE UNDERCROSSING
Contractor Name: AMERICAN CIVIL CONSTRUCTORS WEST COAST LLC
Contractor Address: 2990 Bay Vista Court, Benicia, CA 94510
Resident Engineer: DANIEL CHAPA Structure Rep.: Nathan Quiroz
DIME Sample ID: 2019-10-01-11
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: 10/01/2019
Date that the sample was received by the laboratory/organization performing the testing: 10/01/2019
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 Polymers and Reichhold
