Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215168 DEA: 101C5004 EFIS: 1016000026
QA Service Level: 1
DIST-CO-RTE-PM: 10-SJ-4,5-T15.5/R16.7,25.8/26.5
Work Description: CONSTRUCT JPCP, CRCP, AND APPROACH SLABS.
Location Description: SAN JOAQUIN COUNTY IN STOCKTON ON ROUTE 4 FROM 0.2 MILE EAST OF FRESNO AVENUE TO EL DORADO STREET AND ON ROUTE 5 FROM TAYLOR STREET OVERHEAD TO STOCKTON CHANNEL VIADUCT
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVE, SYLMAR, CA, 91342
Resident Engineer: Stan Oshita Structure Rep.: Daniel Laureno
DIME Sample ID: 2021-11-01-53
TL Number from the TL Form: 923937
Sample Submitted By Organization: CT HQ - Sacramento Concrete Testing Laboratory
Sample Organization Contact: (916) 594-1991
Type of Sample: Quality Assurance
Type of Material: Rapid Set
Sample Taken Date: 11/01/2021
Date that the sample was received by the laboratory/organization performing the testing: 11/02/2021
The quantity of what the sample constitutes: 2 bags
A brief description of the sample: Rapid Set DOT
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CTS
