Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994605 DEA: 101N5104 EFIS: 1021000203
QA Service Level: 1
DIST-CO-RTE-PM: 10-SJ-5-R23.9
Work Description: REPLACE JOINT SEALS AND PLACE POLYESTER CONCRETE OVERLAY ON BRIDGE.
Location Description: SAN JOAQUIN COUNTY IN STOCKTON AT WALKER SLOUGH BRIDGE
Contractor Name: MYERS & SONS CONSTRUCTION, LLC
Contractor Address: 45 Morrison Ave, Sacramento, CA 95838
Resident Engineer: Tofael Anwar Structure Rep.: Unknown
DIME Sample ID: 2024-04-23-6
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3665 - Stockton
Sample Organization Contact: (916) 416-7793
Type of Sample: Department Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 04/23/2024
Date that the sample was received by the laboratory/organization performing the testing: 04/26/2024
The quantity of what the sample constitutes: None
A brief description of the sample: Skid Testing Request
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name: Walker Slough Br. No. 29-0223L/R
The fabricator/manufacturer/facility name: Kwik Bond Polymers
Pavement Surface Type: Polyester Concrete
Type of Traffic Control Provided: Stationary Lane Closure
DIST-CO-RTE: D10-SJ-Hwy 5
Direction of Travel: South
Post Mile: 23.90
Lanes to be Tested: Lane #2
Station:
