Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213733 DEA: 051C85U4 EFIS: 0518000156
QA Service Level: 1
DIST-CO-RTE-PM: 05-SCR-1-10.2/17.5
Work Description: Santa Cruz 1 CAPM and Bridge Rails
Location Description: SANTA CRUZ COUNTY IN AND NEAR SANTA CRUZ FROM NORTH APTOS UNDERPASS TO JUNCTION ROUTE 9.
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 585 West Beach Street, Watsonville, CA 95076
Resident Engineer: Gareth Gill Structure Rep.: Unknown
DIME Sample ID: 2020-02-14-16
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: Verification
Type of Material: Warm Mix Asphalt Technology
Sample Taken Date: 02/14/2020
Date that the sample was received by the laboratory/organization performing the testing: 03/04/2020
The quantity of what the sample constitutes: One JMF
A brief description of the sample: Quart Can WMA
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Salinas
