Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994395 DEA: 070W2704 EFIS: 0721000223
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-710-10.5/32.5
Work Description: POLYESTER CONCRETE OVERLAY, APPLY METHACRYLATE & REPLACE JOINT SEALS
Location Description: LOS ANGELES COUNTY AT VARIOUS LOCATIONS FROM COMPTON CREEK BRIDGE TO UNION STREET OVERCROSSING
Contractor Name: Peterson Chase General Engineering
Contractor Address: 16351 Construction Circle West, Irvine, CA 92606
Resident Engineer: Ramon Robillos Structure Rep.: Matthew Remo
DIME Sample ID: 2023-06-19-40
TL Number from the TL Form: Sacramento Caltrans lab
Sample Submitted By Organization: Kwik Bond Polymers
Sample Organization Contact: (760) 518-6064
Type of Sample: Quality Control
Type of Material: Polyester
Sample Taken Date: 06/19/2023
Date that the sample was received by the laboratory/organization performing the testing: 06/20/2023
The quantity of what the sample constitutes: 6 tankers
A brief description of the sample: 1 gallon can
From where was the sample collected: Source
Laboratory sample identification: 943809
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kwik Bond Polymers, Benicia
