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: 2024-11-01-48
TL Number from the TL Form:
Sample Submitted By Organization: Sequoia Consultants
Sample Organization Contact: (714) 974-6316
Type of Sample: Quality Control
Type of Material: Aggregate
Sample Taken Date: 11/01/2024
Date that the sample was received by the laboratory/organization performing the testing: 11/01/2024
The quantity of what the sample constitutes: 1 per batch
A brief description of the sample: 1x4 concrete aggregates
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Cemex Santa Barbara
Source Identification (SMARA, name of Pit or Job Site): 91-56-0032
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 or belt cut
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
