Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994729 DEA: 034H88U4 EFIS: 0323000024
QA Service Level: 1
DIST-CO-RTE-PM: 03-BUT-32-0.3/5.0
Work Description: INSTALL LIGHTING, WIDEN SHLD, UPGRADE END TREATMENTS, EXTEND CULVERTS.
Location Description: BUTTE COUNTY NEAR CHICO FROM 0.3 MILE EAST OF BUTTE COUNTY LINE TO MUIR AVENUE
Contractor Name: BALDWIN CONTRACTING COMPANY INC. DBA KNIFE RIVER CONSTRUCTION
Contractor Address: 1764 SKYWAY, CHICO, CA 95928
Resident Engineer: Dustin Watts Structure Rep.: Nicholas McLean
DIME Sample ID: 2023-09-11-7
TL Number from the TL Form: 802139
Sample Submitted By Organization: CT D03 - Chico Field Laboratory
Sample Organization Contact: (916) 799-4305
Type of Sample: Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 09/11/2023
Date that the sample was received by the laboratory/organization performing the testing: 09/11/2023
The quantity of what the sample constitutes: 750 Tons
A brief description of the sample: 3/4 RHMA-G
From where was the sample collected: Supplier
Laboratory sample identification: L1S12
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: KRC Orland Drum Plant
