Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 209129 DEA: 080J0104 EFIS: 0800000278
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-18-53.5
Work Description: CONSTRUCT LEFT TURN IN BOTH DIRECTIONS, WIDEN SHOULDER WEST BOUND
Location Description: SAN BERNARDINO COUNTY AT BIG BEAR CITY AT BIG TREE DRIVE
Contractor Name: POWELL CONSTRUCTORS, INC.
Contractor Address: 8555 Banana Ave., Fontana, Ca 92335
Resident Engineer: Nhan Nguyen Structure Rep.: Unknown
DIME Sample ID: 2014-05-21-6308496
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Acceptance
Type of Material: Soil
Sample Taken Date: 05/21/2014
Date that the sample was received by the laboratory/organization performing the testing: 05/24/2014
The quantity of what the sample constitutes: 1 Bag
A brief description of the sample: Soil for Subgrade.
From where was the sample collected: Source
Laboratory sample identification: 4145B
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Rte. 18 Sta. 16 60 to 24 00.
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Rte. 18 Sta. 16 60 to 24 00.
Where the material sample would have been placed if not sampled:
