Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000216 DEA: 081G6304 EFIS: 0816000043
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-111-47.2/55.3
Work Description: RHMA-G, REPLACE AC SURFACING, AND COLD PLANE AC PVMT.
Location Description: RIVERSIDE COUNTY IN PALM SPRINGS FROM GOLF CLUB DRIVE TO WEST GATEWAY DRIVE
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 3800 Monroe St, Indio Ca 92203
Resident Engineer: Francisco Montellano Structure Rep.: Unknown
DIME Sample ID: 2024-10-30-50
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Verification
Type of Material: Aggregate
Sample Taken Date: 10/30/2024
Date that the sample was received by the laboratory/organization performing the testing: 11/21/2024
The quantity of what the sample constitutes: 4 BAGS COMB AGGS(3/4,1/2,3/8, CRUSHER FINES,5 ROCK), 1 BAG OF HI-NAT,1 BAG OF CRUMBRUBBER
A brief description of the sample: 3/4" RHMA-G-SP 0.50% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0640G-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Construction Company
Source Identification (SMARA, name of Pit or Job Site): 91-33-0072
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: INGEVITY,CRM,SJR,GRANITE,VLO,WEST COAST AGG
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: JMF 1556
Lot number:
Sublot number:
Aggregate Mix Number:
