Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993882 DEA: 041Q3404 EFIS: 0418000242
QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-1-21.84
Work Description:
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2022-06-08-12
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Per Request
Type of Material: Soil
Sample Taken Date: 06/08/2022
Date that the sample was received by the laboratory/organization performing the testing: 06/10/2022
The quantity of what the sample constitutes: near the inlet of culvert
A brief description of the sample: Native Soil
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: N/A
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: near the inlet of culvert at PM 21.84 on US north 1 near jenner
Where the material sample would have been placed if not sampled:
