Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993271 DEA: 11430604 EFIS: 1119000026
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-8,805-5.6/17.4
Work Description: INSTALL HIGH FRICTION SURFACE TREATMENT
Location Description: FOR CONSTRUCTION ON STATE HIGHWAY IN SAN DIEGO COUNTY IN SAN DIEGO ON ROUTE 8 AT ROUTE 15/8 SEPARATION AND ON ROUTE 805 AT NORTHBOUND 805 TO EASTBOUND 8 CONNECTOR
Contractor Name: HAZARD CONSTRUCTION COMPANY
Contractor Address: 10529 Vine Street, Lakeside, CA, 92040
Resident Engineer: Genaro Genel-Trujillo Structure Rep.: Unknown
DIME Sample ID: 2022-05-31-4
TL Number from the TL Form: Sacramento Caltrans lab
Sample Submitted By Organization: Kwik Bond Polymers
Sample Organization Contact: (760) 518-6064
Type of Sample: Quality Control
Type of Material: Polyester
Sample Taken Date: 05/31/2022
Date that the sample was received by the laboratory/organization performing the testing: 05/31/2022
The quantity of what the sample constitutes: 2 tankers
A brief description of the sample: 1 gallon can
From where was the sample collected: Source
Laboratory sample identification: 943113
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kwik Bond Polymers, Benicia
