Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994157 DEA: 041K7504 EFIS: 0416000309
QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-1-41.2/54.6
Work Description: REMOVE CULVERT, RCP, CORRUGATED STEEL PIPE AND CONCRETE BACK FILL.
Location Description: SONOMA COUNTY AT VARIOUS LOCATIONS FROM 0.2 MILE NORTH OF MILLER CREEK TO 0.1 MILE NORTH OF VANTAGE ROAD
Contractor Name: WYLATTI RESOURCE MANAGEMENT, INC.
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2022-07-27-32
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: 07/27/2022
Date that the sample was received by the laboratory/organization performing the testing: 08/03/2022
The quantity of what the sample constitutes: Sample B
A brief description of the sample: a sand bag filled with native soil taken at depth approx. 2.25ft near the culvert @ PM51.94
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: Sample B
A detailed description of where the material sample was collected: near the inlet of culvert at coordinates 38.6956, -123.4309
Where the material sample would have been placed if not sampled:
