Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 208714 DEA: 08043514 EFIS: 0800000010
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-58-R22.2/R31.1
Work Description: REALIGN AND WIDEN 2 TO 4 LANES EXPRESSWAY
Location Description: HINKLEY ROAD FROM 2.4 MILES WEST OF HIDDEN RIVER ROAD TO? 0.7 MILE EAST OF LENWOOD ROAD.
Contractor Name: Skanska Civil USA
Contractor Address: 1995 Agua Mansa Road, Riverside, CA 92509
Resident Engineer: Shaine Shahidi Structure Rep.: Ahmad Ankir
DIME Sample ID: 2015-11-04-3
TL Number from the TL Form: Unknown
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Department Acceptance
Type of Material: Soil
Sample Taken Date: 11/04/2015
Date that the sample was received by the laboratory/organization performing the testing: 11/06/2015
The quantity of what the sample constitutes: 2 Bags
A brief description of the sample: Soil for Embankment
From where was the sample collected: Source
Laboratory sample identification: 5278B
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: NA
The fabricator's/manufacturer's product name for the sample: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: Lynx Site Sta 1408 00
Where the material sample would have been placed if not sampled: Unknown