Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993590 DEA: 101J2004 EFIS: 1018000147
QA Service Level: 1
DIST-CO-RTE-PM: 10-SJ-26-8.0/17.8
Work Description: COLD PLANE AND HMA OVERLAY.
Location Description: SAN JOAQUIN COUNTY AT AND NEAR LINDEN AT VARIOUS LOCATIONS FROM 0.7 MILE EAST OF GOGNA ROAD TO 1.3 MILES WEST OF SHELLEY ROAD
Contractor Name: George Reed Inc.
Contractor Address: 140 Empire Ave, Modesto, CA 95354
Resident Engineer: Troy Scheiber Structure Rep.: Unknown
DIME Sample ID: 2022-09-26-59
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Hot Mix Asphalt Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Informational
Type of Material: Hot Mix Asphalt
Sample Taken Date: 09/26/2022
Date that the sample was received by the laboratory/organization performing the testing: 09/26/2022
The quantity of what the sample constitutes: 24 boxes
A brief description of the sample: 3/4" HMA-A
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: George Reed - Clements