Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214424 DEA: 051F6304 EFIS: 0514000040
QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO-41-14.2/15.9
Work Description: ROUTE 41 ATASCADERO ADA PROJECT; CONSTRUCT ADA PATHWAYS AND RAMPS, DRAINAGE SYSTEMS AND SIGNALS.
Location Description: SAN LUIS OBISPO COUNTY IN ATASCADERO FROM SAN GABRIEL ROAD TO ROUTE 101/41 SEPARATION
Contractor Name: SOUZA CONSTRUCTION
Contractor Address: 4027 Santa Fe Road, San Luis Obispo, CA 93403
Resident Engineer: Hassan Iman Structure Rep.: Unknown
DIME Sample ID: 2020-03-03-27
TL Number from the TL Form:
Sample Submitted By Organization: CalPortland
Sample Organization Contact: (805) 345-3472
Type of Sample: Preliminary
Type of Material: Hot Mix Asphalt
Sample Taken Date: 03/03/2020
Date that the sample was received by the laboratory/organization performing the testing: 03/03/2020
The quantity of what the sample constitutes: 28 bags
A brief description of the sample: Hot Bin Samples for JMF
From where was the sample collected: Source
Laboratory sample identification: 1463794780
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CalPortland Paso Robles
