Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214977 DEA: 040J5204 EFIS: 0414000009
QA Service Level: 1
DIST-CO-RTE-PM: 04-ALA-580-R8.0
Work Description: REPAIR SPALLED SURFACE AREA AND PLACE STRUCTURAL CONCRETE BRIDGE.
Location Description: ALAMEDA COUNTY AT LIVERMORE AT GREENVILLE OVERHEAD
Contractor Name: TRUESDELL CORP OF CALIFORNIA INC
Contractor Address: 1310 W 23RD STREET, TEMPE AZ 85282
Resident Engineer: Eddie Dike Structure Rep.: John Parecadan
DIME Sample ID: 2021-01-11-14
TL Number from the TL Form: C
Sample Submitted By Organization: CT HQ - Sacramento Aggregate Testing Laboratory
Sample Organization Contact: (916) 227-7204
Type of Sample: Per Request
Type of Material: Concrete Core
Sample Taken Date: 01/11/2021
Date that the sample was received by the laboratory/organization performing the testing: 02/18/2021
The quantity of what the sample constitutes: 1-2x2 cube
A brief description of the sample: Sikacrete 211SCC plus cube
From where was the sample collected: Supplier
Laboratory sample identification: 21-0024
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: sika - Milpitas
