Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994244 DEA: 051F6204 EFIS: 0514000039
QA Service Level: 1
DIST-CO-RTE-PM: 05-SCR-152-1.9
Work Description: WIDEN BRIDGE, CONCRETE BARRIER, AND MODIFY ELECTRICAL SYSTEM.
Location Description: SANTA CRUZ COUNTY NEAR WATSONVILLE AT CORRALITOS CREEK BRIDGE
Contractor Name: Bridgeway Civil Constructors, Inc
Contractor Address: 3333 Vaca Valley Parkway, Suite 2000, Vacaville, CA 95688
Resident Engineer: David Hopper Structure Rep.: David Galarza
DIME Sample ID: 2023-07-31-39
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Monterey Construction Field Laboratory
Sample Organization Contact: 831-818-0254
Type of Sample: Quality Assurance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 07/31/2023
Date that the sample was received by the laboratory/organization performing the testing: 07/31/2023
The quantity of what the sample constitutes: Tack between lifts
A brief description of the sample: SS-1H 1jug tack coat emulsion
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Reed and Graham, Inc
