Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993169 DEA: 050A0904 EFIS: 0513000028
QA Service Level: 1
DIST-CO-RTE-PM: 05-MON-156-R1.4/R2.0
Work Description: WIDEN REINFORCED STRUCTURAL CONCRETE BRIDGE & REPLACE BRIDGE RAILING.
Location Description: MONTEREY COUNTY IN AND NEAR CASTROVILLE FROM 0.3 MILE EAST OF ROUTE 156/183 SEPARATION TO 0.2 MILE EAST OF CASTROVILLE BOULEVARD
Contractor Name: Granite Rock (Bryan Jones)
Contractor Address: 5225 Hellyer Ave, Ste 220, San Jose, CA 95138
Resident Engineer: David Hopper Structure Rep.: Dean Russu
DIME Sample ID: 2023-11-13-5
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: 11/13/2023
Date that the sample was received by the laboratory/organization performing the testing: 11/13/2023
The quantity of what the sample constitutes: 1 JG
A brief description of the sample: SS-1H
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pacific Northwest Oil - Stockton, CA
