Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213764 DEA: 080F0304 EFIS: 0800020358
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-60-R0.7/R3.0
Work Description: REMOVE AND REPLACE THREE OVERCROSSING BRIDGES ON ROUTE 60
Location Description: IN SAN BERNARDINO COUNTY IN AND NEAR CHINO AT VARIOUS LOCATIONS FROM O.1 MILE WEST OF PIPELINE AVENUE OVERCROSSING TO 0.1 MILE EAST OF BENSON AVENUE OVERCROSSING
Contractor Name: SEMA CONSTRUCTION, INC.
Contractor Address: 42690 Rio Nedo, Suite G, Temecula, CA 92590
Resident Engineer: Joseph Lopez Structure Rep.: Rodrigo Santa Cruz
DIME Sample ID: 2021-06-01-4
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Sample Organization Contact: (858) 285-5797
Type of Sample: Quality Control
Type of Material: Methacrylate
Sample Taken Date: 06/01/2021
Date that the sample was received by the laboratory/organization performing the testing: 06/01/2021
The quantity of what the sample constitutes: 3
A brief description of the sample: Type 2 Control Cement
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: silika
DIME Test ID: 2021-06-01-4-1
Test Method: ASTM D323-Jun15: Standard Test Method for Vapor Pressure of Petroleum Products (Reid Method)
Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Organization Address: 13230 East Firestone Boulevard,
Organization City: Santa Fe Springs
Organization State: CA
Organization Zipcode: 90670
Organization Email: adriana.ortiz@dot.ca.gov
Organization Phone: (323) 805-3068
Data has not been verified.
