Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993445 DEA: 101M3504 EFIS: 1020000181
QA Service Level: 1
DIST-CO-RTE-PM: 10-SJ-132-L0.7/5.8
Work Description: REPLACE APPROACH SLAB AND PLACE POLYESTER CONCRETE OVERLAY.
Location Description: SAN JOAQUIN COUNTY NEAR VERNALIS AT VARIOUS LOCATIONS FROM ROUTE 132 EAST/580 SEPARATION TO ROUTE 132/33 SEPARATION AND OVERHEAD
Contractor Name: Truesdell Corporation
Contractor Address: 1310 W. 23rd Street, Tempe, AZ 85282
Resident Engineer: David Abledu Structure Rep.: Kyle Sanford
DIME Sample ID: 2022-06-06-10
TL Number from the TL Form:
Sample Submitted By Organization: Sika Corporation
Sample Organization Contact: (562) 941-0231
Type of Sample: Per Request
Type of Material: Rapid Set
Sample Taken Date: 06/06/2022
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 2 bags
A brief description of the sample: Rapid Setting Mortar
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Sika - Santa Fe Springs
