Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993509 DEA: 101K9604 EFIS: 1019000163
QA Service Level: 1
DIST-CO-RTE-PM: 10-MER,SJ,TUO-99,205,120-Var
Work Description: REPLACE HMA PAVEMENT AND APPLY HIGH FRICTION SURFACE TREATMENT.
Location Description: MERCED, SAN JOAQUIN, AND TUOLUMNE COUNTIES AT VARIOUS LOCATIONS
Contractor Name: AMERICAN CIVIL CONSTRUCTORS WEST COAST LLC
Contractor Address: 2990 Bay Vista Court, Benicia, CA 94510
Resident Engineer: Bal Bahadur Paul Structure Rep.: Unknown
DIME Sample ID: 2022-04-29-31
TL Number from the TL Form: 730511
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: 04/29/2022
Date that the sample was received by the laboratory/organization performing the testing: 05/02/2022
The quantity of what the sample constitutes: 16 boxes,5bags,2 cans
A brief description of the sample: 3/4 HMA-SP 15% Rap
From where was the sample collected: Source
Laboratory sample identification: 22-J-007
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: George Reed - Table Mountain Plant
