Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993292 DEA: 041W7501 EFIS: 0421000091
QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-121-
Work Description:
Location Description:
Contractor Name: Rage Construction Inc
Contractor Address: 600 Santana Drive, Cloverdale CA 95425
Resident Engineer: Sardar Chalabe Structure Rep.: Unknown
DIME Sample ID: 2021-10-14-6
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: Per Request
Type of Material: Soil
Sample Taken Date: 10/14/2021
Date that the sample was received by the laboratory/organization performing the testing: 10/15/2021
The quantity of what the sample constitutes: 1 bag, approx 6-8 lbs
A brief description of the sample: Soil Sample Native Selected
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Field
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: Culvert Inlet @ PM 4.07 , 38.2034 E, -122.2449N
Where the material sample would have been placed if not sampled:
