Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214253 DEA: 051J0404 EFIS: 0517000054
QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO,MON-46,101-49.5,R3.1/R5.2
Work Description: INSTALL ELECTRIC VEHICLE CHARGING STATIONS.
Location Description: SAN LUIS OBISPO AND MONTEREY COUNTIES ON ROUTE 46 AT SHANDON SAFETY ROADSIDE REST AREA AND ON ROUTE 101 AT CAMP ROBERTS SAFETY ROADSIDE REST AREAS
Contractor Name: Hoseley Corp
Contractor Address: 1485 Bayshore Boulevard, #193, San Francisco, CA 94 124
Resident Engineer: Amy Norris Structure Rep.: Unknown
DIME Sample ID: 2020-04-01-10
TL Number from the TL Form:
Sample Submitted By Organization: CalPortland
Sample Organization Contact: (805) 345-3472
Type of Sample: Quality Control
Type of Material: Hot Mix Asphalt
Sample Taken Date: 04/01/2020
Date that the sample was received by the laboratory/organization performing the testing: 04/01/2020
The quantity of what the sample constitutes: 16 kgs of HMA
A brief description of the sample: HMA Lab Batch - Mix Design
From where was the sample collected: Other
Laboratory sample identification: 1332010353
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CalPortland Santa Maria
