Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212789 DEA: 044H5804 EFIS: 0413000162
QA Service Level: 1
DIST-CO-RTE-PM: 04-ALA,-880-11.8/27.5.4
Work Description: ROADWAY SURFACING, PRECAST JOINT CONCRETE PAVEMENT AND ELECTRICALS
Location Description: ALAMEDA COUNTY IN FREMONT, UNION CITY, HAYWARD, SAN LEANDRO AND OAKLAND FROM 0.4 MILE NORTH OF FREMONT BOULEVARD OVERCROSSING TO HIGH STREET UNDERCROSSING
Contractor Name: O.C. JONES & SONS, INC.
Contractor Address: 1520 Fourth Street, Berkeley, CA 94710
Resident Engineer: Vernon Nguyen Structure Rep.: Betty Geng
DIME Sample ID: 2019-07-12-10
TL Number from the TL Form:
Sample Submitted By Organization: CT D04 - Concord Field Laboratory
Sample Organization Contact: (510) 714-7019
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 07/12/2019
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 750 Tons
A brief description of the sample: 1/2" OGFC
From where was the sample collected: Source
Laboratory sample identification: LB
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite
