Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214634 DEA: 051M2404 EFIS: 0519000085
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-21.8/22.0
Work Description: Goleta Cross Slope Correction
Location Description:
Contractor Name: CAL PORTLAND CONSTRUCTION
Contractor Address: 1625 E Donovan Road, Santa Maria, CA 93454
Resident Engineer: Kevin Murdock Structure Rep.: Unknown
DIME Sample ID: 2020-01-30-19
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Field Laboratory
Sample Organization Contact: (559) 230-3109
Type of Sample: Verification
Type of Material: Asphalt Binder
Sample Taken Date: 01/30/2020
Date that the sample was received by the laboratory/organization performing the testing: 01/31/2020
The quantity of what the sample constitutes: Verification Testing
A brief description of the sample: 1 Quart can
From where was the sample collected: Other
Laboratory sample identification: D5 20-J-001
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: World Oil