Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994120 DEA: 040J6314 EFIS: 0421000252
QA Service Level: 1
DIST-CO-RTE-PM: 04-SOL-12-21.2/22.6
Work Description: ROADWAY RESURFACING, INSTALL DRAINAGE SYSTEM, MIDWEST GUARDRAIL SYSTEM
Location Description: SOLANO COUNTY NEAR RIO VISTA FROM MCCLOSKY ROAD TO 0.1 MILE WEST OF AZEVEDO ROAD
Contractor Name: Bay Cities Paving & Grading (David Jimenez)
Contractor Address: 1450 Civic Ct. BLDG B #400, Concord CA, 94520
Resident Engineer: Noel Aquino Structure Rep.: Unknown
DIME Sample ID: 2023-08-11-51
TL Number from the TL Form:
Sample Submitted By Organization: CT D04 - Concord Field Laboratory
Sample Organization Contact: (510) 714-7019
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 08/11/2023
Date that the sample was received by the laboratory/organization performing the testing: 08/18/2023
The quantity of what the sample constitutes: LOT 1 SUBLOT 6
A brief description of the sample: 1/2-INCH HMA Types A and B W/12%RAP
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Vernanlis -Tracy Drum Plant
