Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 209694 DEA: 080J0704 EFIS: 0800000282
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-215-0.6/1.7
Work Description: (Alternative Delivery) The CMGC project will reconstruct and improve interchange of I-215 and Barton Road in the City of Grand Terrace, CA.
Location Description: Grade separation at Intersection of I-215 and Barton Road near Grand Terrace, CA. ? On I-215 between I-10 and SR-60.
Contractor Name: Myers / Rados-Southern California Jobsite Office
Contractor Address: 12210 Michigan St., Suite D, Grand Terrace, CA 92313
Resident Engineer: Fereydoon Alipanah Structure Rep.: Tim Flores
DIME Sample ID: 2014-09-17-11
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Preliminary
Type of Material: Soil
Sample Taken Date: 09/17/2014
Date that the sample was received by the laboratory/organization performing the testing: 09/17/2014
The quantity of what the sample constitutes: 2 Bags
A brief description of the sample: Soil
From where was the sample collected: Source
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: SB off ramp in front of pet salon 12012 Lacrosse Ave
The fabricator's/manufacturer's product name for the sample: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: SB off ramp in front of pet salon 12012 Lacrosse Ave
Where the material sample would have been placed if not sampled: Unknown
