Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 211166 DEA: 051H1404 EFIS: 0516000030
QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO--
Work Description: LIGHTING & PUMP PLANT ELECTRICAL REPAIR
Location Description:
Contractor Name: Electricraft Inc.
Contractor Address: 205 South St, San Luis Obispo, Ca 93401
Resident Engineer: Patrick Stimson Structure Rep.: Unknown
DIME Sample ID: 2022-01-04-6
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - San Luis Obispo District Laboratory
Sample Organization Contact: (559) 230-3109
Type of Sample: Preliminary
Type of Material: Soil
Sample Taken Date: 01/04/2022
Date that the sample was received by the laboratory/organization performing the testing: 12/20/2021
The quantity of what the sample constitutes: unknown
A brief description of the sample: dirt
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Mother Earth
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
Where the material sample would have been placed if not sampled:
