Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213942 DEA: 051F7004 EFIS: 0514000055
QA Service Level: 1
DIST-CO-RTE-PM: 05-MON-101-73.1/87.3
Work Description: REPLACE CONCRETE PANEL AND RESURFACE HMA PAVEMENT.
Location Description: MONTEREY COUNTY NEAR CHUALAR FROM 0.5 MILE NORTH OF NORTH GONZALES OVERCROSSING TO EAST MARKET STREET UNDERCROSSING
Contractor Name: Granite Rock Company
Contractor Address: 5225 Hellyer Avenue Suite 220, San Jose, CA 95138
Resident Engineer: Tyler Lavering Structure Rep.: Unknown
DIME Sample ID: 2020-03-03-26
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: Antistrip Additive
Sample Taken Date: 03/03/2020
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: One JMF Renewal
A brief description of the sample: One JMF Renewal
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Graniterock Aromas Drum
