Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215050 DEA: 080R1424 EFIS: 0815000201
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-40-R125.0/R154.6
Work Description: ROADWAY EXCAVATION, IMPORT BORROW AND REGRADE THE MEDIAN SLOPE.
Location Description: SAN BERNARDINO COUNTY FROM 4.5 MILES EAST OF HOMER WASH BRIDGE TO ARIZONA STATE LINE
Contractor Name: Ames Construction
Contractor Address: 391 N. MAIN STREET, CORONA CA 92880
Resident Engineer: Darcy Davis Structure Rep.: Unknown
DIME Sample ID: 2022-04-12-22
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Barstow Field Laboratory 1
Sample Organization Contact: (760) 252-9216
Type of Sample: Quality Assurance
Type of Material: Soil
Sample Taken Date: 04/12/2022
Date that the sample was received by the laboratory/organization performing the testing: 04/12/2022
The quantity of what the sample constitutes: 540 SQF
A brief description of the sample: Soil
From where was the sample collected: Job Site
Laboratory sample identification: 04122022 test 05
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CTM 231 TEST LOCATION
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: AT THE JOBSITE
Where the material sample would have been placed if not sampled:
