Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 211783 DEA: 07307204 EFIS: 0714000216
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-91,105,110,and405-Varies
Work Description: PLACE HIGH FRICTION SURFACE TREATMENT.
Location Description: LOS ANGELES COUNTY AT VARIOUS LOCATIONS
Contractor Name: MYERS AND SONS CONSTRUCTION, LP
Contractor Address: 4600 NORTHGATE BLVD. SUITE 10 , SACRAMENTO CA 95834
Resident Engineer: Edgar Herrera Structure Rep.: Unknown
DIME Sample ID: 2019-11-08-10
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: 11/08/2019
Date that the sample was received by the laboratory/organization performing the testing: 11/08/2019
The quantity of what the sample constitutes: 2 tankers 12 totes
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
