Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 211071 DEA: 080R9504 EFIS: 0812000218
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-371-70.6/70.9
Work Description: CONSTRUCT LEFT TURN LANES
Location Description: CONSTRUCT LEFT TURN LANES
Contractor Name: ALL AMERICAN ASPHALT
Contractor Address: Unknown
Resident Engineer: Nick Troung Structure Rep.: Unknown
DIME Sample ID: 2016-07-05-3
TL Number from the TL Form: C 985251
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Acceptance
Type of Material: Soil
Sample Taken Date: 07/05/2016
Date that the sample was received by the laboratory/organization performing the testing: 07/05/2016
The quantity of what the sample constitutes: 1 Bag
A brief description of the sample: Soil
From where was the sample collected: Source
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: NA
The fabricator's/manufacturer's product name for the sample: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: NW Shoulder Sta 760 00
Where the material sample would have been placed if not sampled: Unknown
