Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994310 DEA: 034F6504 EFIS: 0314000233
QA Service Level: 1
DIST-CO-RTE-PM: 03-YOL-50,80-0.0/2.5,4.1/R11.4
Work Description: CRCP, HMA (TYPE A), RDWY EXC, CLASS 2 AB, FIBER OPTIC CABLE SYSTEMS.
Location Description: YOLO COUNTY IN AND NEAR WEST SACRAMENTO ON ROUTE 80 FROM 1.7 MILES EAST OF MACE BOULEVARD OVERCROSSING TO SACRAMENTO RIVER BRIDGE AND OVERHEAD (BRYTE BEND) AND ON ROUTE 50 FROM ROUTE 80 JUNCTION TO JEFFERSON BOULEVARD UNDERCROSSING
Contractor Name: Flat-Iron Teichert A Joint Venture
Contractor Address: 1200 Concord Avenue Suite 465, Concord, CA 94520
Resident Engineer: Daniel Tecle Structure Rep.: Brent Bullard
DIME Sample ID: 2024-04-08-32
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: 04/08/2024
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 2 HMA Boxes
A brief description of the sample: 1/2" SP PG64-16 w/ RAP
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Perkins
