Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 55556 DEA: OCR EFIS: OCR
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for submitting Sample information for Oregon Corp. Research.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2024-06-18-124
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Proficiency
Type of Material: Asphaltic Emulsion
Sample Taken Date: 06/18/2024
Date that the sample was received by the laboratory/organization performing the testing: 07/01/2024
The quantity of what the sample constitutes: 1 bottle
A brief description of the sample: CRS-2P Emulsion
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Ergon Asphalt and Emulsions
