Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213835 DEA: 051F7404 EFIS: 0514000049
QA Service Level: 1
DIST-CO-RTE-PM: 05-MON-101-R28.0/R30.6
Work Description: PLACE CONTINUOUSLY REINFORCED CONCRETE PAVEMENT ON EXISTING ROADWAY.
Location Description: MONTEREY COUNTY NEAR SAN LUCAS FROM 0.1 MILE SOUTH OF PARIS VALLEY ROAD OVERCROSSING TO RANCHO UNDERCROSSING
Contractor Name: PAPICH CONSTRUCTION COMPANY, INC.
Contractor Address: 398 SUNRISE TERRACE, ARROYO GRANDE, CA 93425
Resident Engineer: Amy Norris Structure Rep.: Juan Moreno
DIME Sample ID: 2020-03-03-11
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - San Luis Obispo District Laboratory
Sample Organization Contact: (559) 230-3109
Type of Sample: Preliminary
Type of Material: Soil
Sample Taken Date: 03/03/2020
Date that the sample was received by the laboratory/organization performing the testing: 03/04/2020
The quantity of what the sample constitutes: Existinc Conditions
A brief description of the sample: Clayey Soil Sample
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Mother Earth
The fabricator's/manufacturer's product name for the sample: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: From the Native Subgrade
Where the material sample would have been placed if not sampled: Unknown
