Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215179 DEA: 010F4704 EFIS: 0116000011
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-299-30.7/37.7
Work Description: PLACE HMA & RHMA-G & CONSTRUCT SOLDIER PILE WALL.
Location Description: HUMBOLDT COUNTY NEAR WILLOW CREEK AT VARIOUS LOCATIONS FROM 0.1 MILE EAST OF CEDAR CREEK ROAD TO 1.1 MILES WEST OF ROUTE 96 JUNCTION
Contractor Name: MERCER-FRASER COMPANY
Contractor Address: PO Box 1006, Eureka, CA 95502
Resident Engineer: Brian Winter Structure Rep.: Jarred Burrows
DIME Sample ID: 2021-04-19-41
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Hot Mix Asphalt Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Dispute Resolution
Type of Material: Hot Mix Asphalt
Sample Taken Date: 04/19/2021
Date that the sample was received by the laboratory/organization performing the testing: 06/08/2021
The quantity of what the sample constitutes: boxes
A brief description of the sample: 3/4" HMA PG64-16 NO RAP
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Mercer Fraser - Willow Creek
