Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214688 DEA: 042K1404 EFIS: 0416000373
QA Service Level: 1
DIST-CO-RTE-PM: 04-SCL-17-0.0/3.4
Work Description: LIGHTING AND TRAFFIC SYSTEMS, REPLACE GUARDRAIL, PAVING AND STRIPING.
Location Description: SANTA CLARA COUNTY IN REDWOOD ESTATE AND HOLY CITY FROM 0.1 MILE SOUTH OF ROUTE 17/35 SEPARATION TO 0.1 MILE NORTH OF ALMA COLLEGE ROAD
Contractor Name: AMERICAN CIVIL CONSTRUCTORS WEST COAST LLC
Contractor Address: 2990 Bay Vista Court, Benicia, CA 95122
Resident Engineer: Minh Hinh Structure Rep.: Unknown
DIME Sample ID: 2020-08-07-21
TL Number from the TL Form: Sacramento Caltrans lab
Sample Submitted By Organization: Kwik Bond Polymers
Sample Organization Contact: (760) 518-6064
Type of Sample: Quality Control
Type of Material: Polyester
Sample Taken Date: 08/07/2020
Date that the sample was received by the laboratory/organization performing the testing: 08/07/2020
The quantity of what the sample constitutes: 1 Tanker 16 Totes
A brief description of the sample: 1 gallon can
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kwik Bond Polymers and Reichhold
