Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993234 DEA: 051H0004 EFIS: 0516000011
QA Service Level: 1
DIST-CO-RTE-PM: 05-MON-68-1.1/L4.3
Work Description: PLACE HMA AND MODIFY SIGNAL AND LIGHTING SYSTEMS.
Location Description: MONTEREY COUNTY IN AND NEAR PACIFIC GROVE AND MONTEREY FROM FOREST AVENUE TO ROUTE 68/1 SEPARATION
Contractor Name: Graniterock Company
Contractor Address: 350 Technology Drive, Watsonville, CA 95076
Resident Engineer: Tyler Lavering Structure Rep.: Unknown
DIME Sample ID: 2022-05-22-3
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Monterey Construction Field Laboratory
Sample Organization Contact: 831-818-0254
Type of Sample: Department Acceptance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 05/22/2022
Date that the sample was received by the laboratory/organization performing the testing: 05/22/2022
The quantity of what the sample constitutes: 1 Jug
A brief description of the sample: SS-1h Tack Coat
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pacific Northwest Oil - Stockton, CA
