Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993905 DEA: 034H5814 EFIS: 0320000240
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-5-27.6/29.5,30.4/34.3
Work Description: ROADWAY EXCAVATION, PLACE CL2 AB, HMA & RHMA, & MODIFY RAMP METERS.
Location Description: SACRAMENTO COUNTY IN AND NEAR SACRAMENTO FROM 0.5 MILES SOUTH OF ARENA BOULEVARD OVERCROSSING TO 0.4 MILES SOUTH OF 99/5 INTERCHANGE AND FROM 0.5 MILES NORTH OF THE 99/5 INTERCHANGE TO 0.4 MILE SOUTH OF THE YOLO COUNTY LINE
Contractor Name: DeSILVA GATES CONSTRUCTION
Contractor Address: 3855 N Freeway, Ste. 100, Sacramento, CA 95834
Resident Engineer: Hani Eissa Structure Rep.: Brent Bullard
DIME Sample ID: 2023-12-12-26
TL Number from the TL Form:
Sample Submitted By Organization: Blackburn Consulting
Sample Organization Contact: (916) 375-8706
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 12/12/2023
Date that the sample was received by the laboratory/organization performing the testing: 12/13/2023
The quantity of what the sample constitutes: 2 HMA Boxes
A brief description of the sample: 3/4" HMA w/ 25% RAP
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: DeSilva Gates Construction
