Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214590 DEA: 043G4744 EFIS: 0412000074
QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN,MRN-580-6.9/7.8,0.0/2.5
Work Description: CLEAN AND PAINT STRUCTURAL STEEL BRIDGE.
Location Description: CONTRA COSTA AND MARIN COUNTIES IN RICHMOND AND SAN RAFAEL FROM 0.8 MILE WEST OF TOLL PLAZA TO 0.1 MILE EAST OF MAIN STREET
Contractor Name: Allied Painting, INC.
Contractor Address: 4 Larwin Road, Cherry Hill, NJ08034
Resident Engineer: Behzad Halali Structure Rep.: William Sommer
DIME Sample ID: 2023-04-06-14
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3672 - Richmond
Sample Organization Contact: (510) 231-7108
Type of Sample: Quality Assurance
Type of Material: Rapid Set
Sample Taken Date: 04/06/2023
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 1.14 CY
A brief description of the sample: Four 6x12 - 7 days and 28 days
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier: 28-0100
Structure name: Richmond-San Rafael Bridge
The fabricator/manufacturer/facility name: Precision Concrete
