Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993208 DEA: 034F38U4 EFIS: 0321000092
QA Service Level: 1
DIST-CO-RTE-PM: 03-YUB-70-16.2/25.8
Work Description: WIDEN SHOULDERS AND IMPROVE CLEAR RECOVERY ZONE.
Location Description: YUBA COUNTY NEAR MARYSVILLE FROM 0.2 MILE NORTH OF LAURELLEN ROAD TO SOUTH HONCUT CREEK BRIDGE
Contractor Name: DeSilva Gates
Contractor Address: 11555 Dublin Boulevard, Dublin, CA 94568
Resident Engineer: Manoharan Selvendran Structure Rep.: Unknown
DIME Sample ID: 2023-08-04-51
TL Number from the TL Form: 801980
Sample Submitted By Organization: CT D03 - Olivehurst Northern Regional Laboratory
Sample Organization Contact: (530) 741-4238
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 08/04/2023
Date that the sample was received by the laboratory/organization performing the testing: 08/04/2023
The quantity of what the sample constitutes: 750 Tons
A brief description of the sample: 3/4 HMA
From where was the sample collected: Source
Laboratory sample identification: 23-112
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: DeSilva Gates Aggregates-Marysville
