Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215417 DEA: 101K9304 EFIS: 1020000014
QA Service Level: 1
DIST-CO-RTE-PM: 10-SJ-VAR,580-VAR
Work Description: BRIDGE DECKS INVESTIGATION AND REHABILITATION IN AND NEAR TRACY
Location Description: SJ CTY IN & NEAR TRACY FROM GAFFERY RD TO EAST MIDWAY
Contractor Name: Meyers & Sons
Contractor Address: Unknown
Resident Engineer: Bal Bahadur Paul Structure Rep.: Ron Matin
DIME Sample ID: 2022-01-10-37
TL Number from the TL Form: 034276
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: 01/10/2022
Date that the sample was received by the laboratory/organization performing the testing: 01/11/2022
The quantity of what the sample constitutes: 4 bags, 16 boxes
A brief description of the sample: 1/2" HMA-A
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Materials Vernalis
