Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993590 DEA: 101J2004 EFIS: 1018000147
QA Service Level: 1
DIST-CO-RTE-PM: 10-SJ-26-8.0/17.8
Work Description: COLD PLANE AND HMA OVERLAY.
Location Description: SAN JOAQUIN COUNTY AT AND NEAR LINDEN AT VARIOUS LOCATIONS FROM 0.7 MILE EAST OF GOGNA ROAD TO 1.3 MILES WEST OF SHELLEY ROAD
Contractor Name: George Reed Inc.
Contractor Address: 140 Empire Ave, Modesto, CA 95354
Resident Engineer: Troy Scheiber Structure Rep.: Unknown
DIME Sample ID: 2022-06-14-18
TL Number from the TL Form: 723801
Sample Submitted By Organization: CT D10 - District 10 Materials Laboratory
Sample Organization Contact: (209) 948-7567
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 06/14/2022
Date that the sample was received by the laboratory/organization performing the testing: 06/14/2022
The quantity of what the sample constitutes: 4 boxes
A brief description of the sample: 3/4 HMA-A
From where was the sample collected: Manufacturer
Laboratory sample identification: 22-H-48
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: GR,INC
