Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994538 DEA: 010L1704 EFIS: 0121000078
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-20,101-VAR
Work Description: POLYESTER CONCRETE OVERLAY, HMA, STRUCTURAL CONCRETE, BRIDGE (RSC).
Location Description: MENDOCINO COUNTY AT VARIOUS LOCATIONS
Contractor Name: MYERS & SONS CONSTRUCTION, LLC
Contractor Address: Unknown
Resident Engineer: Daniel Kraft Structure Rep.: Behdad Saebi
DIME Sample ID: 2024-04-19-2
TL Number from the TL Form:
Sample Submitted By Organization: Caltrans IA
Sample Organization Contact: (916) 240-3821
Type of Sample: Quality Assurance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 04/19/2024
Date that the sample was received by the laboratory/organization performing the testing: 04/24/2024
The quantity of what the sample constitutes: skid testing
A brief description of the sample: Skid Testing
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: job site
Pavement Surface Type: PCC (Portland Cement Concrete)
Type of Traffic Control Provided: Moving Lane Closure
DIST-CO-RTE:
Direction of Travel:
Post Mile:
Lanes to be Tested: Lane #1
Station: 123
