Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 210617 DEA: 042J1004 EFIS: 0414000426 COOP: 042549
QA Service Level: 1
DIST-CO-RTE-PM: 04-NAP-29-11.3/11.6
Work Description: CONSTRUCT TWO SEPARATE ROUNDABOUT PROJECTS TOGETHER INTO ONE SINGLE PROJECT AND CONSTRUCTION CONTRACT.
Location Description: AT THE INTERSECTIONS OF FIRST STREET/ CALIFORNIA BLVD AND SECOND STREET/CALIFORNIA BLVD (CITY) AND AT HE STATE ROUTE 29 NORTHBOUND ON AND OFF RAMPS AND FIRST STREET ( CALTRANS)
Contractor Name: O.C. JONES & SONS, INC.
Contractor Address: 1520 4th Street, Berkeley, CA 94710
Resident Engineer: Danilo Patenia Structure Rep.: Mohammad Nasim
DIME Sample ID: 2019-10-25-24
TL Number from the TL Form: NA
Sample Submitted By Organization: CT - Unassigned/General Field Laboratory
Sample Organization Contact: 5625005861
Type of Sample: Per Request
Type of Material: Soil
Sample Taken Date: 10/25/2019
Date that the sample was received by the laboratory/organization performing the testing: 10/25/2019
The quantity of what the sample constitutes: 4 Bags
A brief description of the sample: Structure Backfill
From where was the sample collected: Source
Laboratory sample identification: NA
Structure unique identifier: 28-Napa
Structure name: 29 Roundabout
The fabricator/manufacturer/facility name: OC Jones
The fabricator's/manufacturer's product name for the sample: Structure Backfill
The fabricator/manufacturer designation for the sample: Windrow
A detailed description of where the material sample was collected: Windrow on site
Where the material sample would have been placed if not sampled: footings and roadway
