Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994345 DEA: 023J7804 EFIS: 0222000083
QA Service Level: 1
DIST-CO-RTE-PM: 02-TRI-36-15.8/16.9,20.5/24.5
Work Description: PLACE HOT MIX ASPHALT (TYPE A) AND REPLACE ASPHALT CONCRETE SURFACING.
Location Description: TRINITY COUNTY NEAR FOREST GLEN FROM 1.1 MILES WEST OF SOUTH FORK TRINITY RIVER BRIDGE TO SOUTH FORK TRINITY RIVER BRIDGE NO. 05-0026 AND FROM UPPER RATTLESNAKE CREEK BRIDGE NO. 05-0073 TO 0.3 MILE WEST OF TRINITY PINES ROAD
Contractor Name: TULLIS INC.
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2023-06-07-28
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Materials Management Branch Field Office
Sample Organization Contact: (562) 500-5861
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 06/07/2023
Date that the sample was received by the laboratory/organization performing the testing: 06/07/2023
The quantity of what the sample constitutes: 750 tons or 1 day
A brief description of the sample: 1/2 HMA Type A
From where was the sample collected: Manufacturer
Laboratory sample identification: lot 1 subl 3
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Tullis Inc. - Northstate Asphalt (Redding CA)
