Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000259 DEA: 050N74V4 EFIS: 0522000043
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-9.2/9.7
Work Description:
Location Description: FOR CONSTRUCTION ON STATE HIGHWAY IN SANTA BARBARA COUNTY AT MONTECITO FROM 0.2 MILE NORTH OF SHEFFIELD DRIVE UNDERCROSSING TO 0.3 MILE SOUTH OF SAN YSIDRO ROAD OVERCROSSING
Contractor Name: Granite Construction Company
Contractor Address: P.O. Box 6744, Santa Barbara, CA 93160
Resident Engineer: Taylor Merlo Structure Rep.: Emiliano Berntsen
DIME Sample ID: 2024-09-25-97
TL Number from the TL Form:
Sample Submitted By Organization: Kie-Con, Incorporated - Antioch
Sample Organization Contact: (925) 331-7122
Type of Sample: Quality Control
Type of Material: Aggregate
Sample Taken Date: 09/25/2024
Date that the sample was received by the laboratory/organization performing the testing: 09/25/2024
The quantity of what the sample constitutes: 27 CY
A brief description of the sample: QC aggregate sampling
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: KIE- CON
Source Identification (SMARA, name of Pit or Job Site): 91-07-0003
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Stockpile
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: fine
The concrete mix design number: K5065-23137
Lot number:
Sublot number:
Aggregate Mix Number:
