Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214995 DEA: 040J5304 EFIS: 0414000010
QA Service Level: 1
DIST-CO-RTE-PM: 04-ALA-880-11.4/12.2
Work Description: PATTERSON SLOUGH BRIDGE DECK REHAB
Location Description: ALAMEDA COUNTY IN FREMONT FROM 0.4 MILE SOUTH TO 0.4 MILE NORTH OF PATTERSON SLOUGH BRIDGE
Contractor Name: OC Jones
Contractor Address: 1520 Fourth Street, Berkeley, CA 94710
Resident Engineer: Rodelio Baluyot Structure Rep.: Dave Nguyen
DIME Sample ID: 2020-05-14-60
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Aggregate Prequalification Program
Type of Material: Hot Mix Asphalt
Sample Taken Date: 05/14/2020
Date that the sample was received by the laboratory/organization performing the testing: 05/14/2020
The quantity of what the sample constitutes: n/a
A brief description of the sample: 3/4 Type A HMA
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Materials - Pleasanton
