Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 66667 DEA: JMFPP EFIS: 0019000043
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for submitting Sample information for JMF Prequalification Program.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2021-01-07-1
TL Number from the TL Form: 265
Sample Submitted By Organization: Gallagher and Burk Materials
Sample Organization Contact: (510) 421-2282
Type of Sample: Per Request
Type of Material: Hot Mix Asphalt
Sample Taken Date: 01/07/2021
Date that the sample was received by the laboratory/organization performing the testing: 12/02/2020
The quantity of what the sample constitutes: Annual
A brief description of the sample: 3/4" HMA-A 25% RAP Verification Sample
From where was the sample collected: Supplier
Laboratory sample identification: MD 6741
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Gallagher and Burk Materials
