Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215093 DEA: 101C2804 EFIS: 1014000134
QA Service Level: 1
DIST-CO-RTE-PM: 10-SJ-99-30.9/31.3
Work Description: RAISED BRIDGES, REALIGN RAMPS AND CONSTRUCT AUXILIARY LANE.
Location Description: SAN JOAQUIN COUNTY IN LODI FROM 0.4 MILE SOUTH OF ROUTE 12/99 SEPARATION TO 0.3 MILE SOUTH OF TURNER ROAD OVERCROSSING
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVE, SYLMAR, CA, 91342
Resident Engineer: Troy Scheiber Structure Rep.: Ehab Wahed
DIME Sample ID: 2021-03-16-16
TL Number from the TL Form: C034715
Sample Submitted By Organization: CT D10 - District 10 Materials Laboratory
Sample Organization Contact: (209) 948-7567
Type of Sample: Verification
Type of Material: Hot Mix Asphalt
Sample Taken Date: 03/16/2021
Date that the sample was received by the laboratory/organization performing the testing: 03/02/2021
The quantity of what the sample constitutes: JMF 16 boxs
A brief description of the sample: 1/2 RHMA G PG64-16 Valero B
From where was the sample collected: Manufacturer
Laboratory sample identification: 21-J-011
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: George Reed - Clements Plant
