Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214395 DEA: 103A7204 EFIS: 1013000259
QA Service Level: 1
DIST-CO-RTE-PM: 10-MER-99-20.1/24.3
Work Description: PLACE CRCP AND HMA.
Location Description: MERCED COUNTY IN AND NEAR ATWATER FROM 0.4 MILE SOUTH OF BUHACH OVERCROSSING TO 0.8 MILE NORTH OF WEST ATWATER OVERHEAD
Contractor Name: Bay Cities Paving & Grading
Contractor Address: 1450 Civic Ct. BLDG B #400, Concord CA, 94520
Resident Engineer: Muhammad Rahman Structure Rep.: Karen Sampson
DIME Sample ID: 2020-12-22-12
TL Number from the TL Form: C034078
Sample Submitted By Organization: CT D10 - District 10 Materials Laboratory
Sample Organization Contact: (209) 948-7567
Type of Sample: Acceptance
Type of Material: Soil
Sample Taken Date: 12/22/2020
Date that the sample was received by the laboratory/organization performing the testing: 01/04/2021
The quantity of what the sample constitutes: 1 bag
A brief description of the sample: Native Mix/ AC Grinding
From where was the sample collected: Job Site
Laboratory sample identification: 21-C-01
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Bay Cities
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: Stockpile, Basin no.4
Where the material sample would have been placed if not sampled:
