Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000854 DEA: 010M7104 EFIS: 0123000058
QA Service Level: 1
DIST-CO-RTE-PM: 01-DN-101-46.18
Work Description: Resurface Smith River Agricultural Inspection Station
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2024-12-10-25
TL Number from the TL Form:
Sample Submitted By Organization: CT D01 - Crescent City Field Laboratory
Sample Organization Contact: (707) 496-5581
Type of Sample: Quality Assurance
Type of Material: Reclaimed Asphalt Pavement
Sample Taken Date: 12/10/2024
Date that the sample was received by the laboratory/organization performing the testing: 12/10/2024
The quantity of what the sample constitutes: 750 Tons
A brief description of the sample: rap
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name: 101/AGG/STATION
The fabricator/manufacturer/facility name: Tidewater Smith River
DIME Test ID: 2024-12-10-25-1
Test Method: CTM 202-November 2011: Method of Test for Sieve Analysis of Fine and Coarse Aggregates
Submitted By Organization: CT D01 - Crescent City Field Laboratory
Organization Address: 1444 Parkway Dr.,
Organization City: Crescent City
Organization State: CA
Organization Zipcode: 95531
Organization Email: clayton.malmberg@dot.ca.gov
Organization Phone: (707) 496-5581
Data has not been verified.
