Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213931 DEA: 081J1304 EFIS: 0817000209
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-10,15,210,18,138-VAR
Work Description: Replace joint seal, resurface bridge deck, install bridge mounted sign
Location Description: In SB County at various locations
Contractor Name: RV CONCRETE, INC.
Contractor Address: 605 E COMMERCIAL ST, ANAHEIM CA 92801
Resident Engineer: Mahfual Alam Structure Rep.: Unknown
DIME Sample ID: 2019-12-02-3
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: 12/02/2019
Date that the sample was received by the laboratory/organization performing the testing: 12/02/2019
The quantity of what the sample constitutes: 36 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
