Sample Record for 2024-03-19-67
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 994686 DEA: 051K4604 EFIS: 0518000210
QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO-46-29.7/32.2
Work Description: COLD PLANE, PLACE HMA, RHMA, CONC PVMT, MODIFY SIGNAL AND LIGHTING.
Location Description: SAN LUIS OBISPO COUNTY IN PASO ROBLES FROM 300 FEET WEST OF ROUTE 101/46 SEPARATION TO 0.1 MILE EAST OF AIRPORT ROAD
Contractor Name: PAPICH CONSTRUCTION COMPANY, INC.
Contractor Address: 800 FARROLL RD, GROVER BEACH, CA 93433
Resident Engineer: Michael Schmidt Structure Rep.: Ray Barajas
Sample Information
DIME Sample ID: 2024-03-19-67
TL Number from the TL Form: 417
Sample Submitted By Organization: CT D05 - Paso Robles Field Laboratory
Sample Organization Contact: 1 (209) 610-9363
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 03/19/2024
Date that the sample was received by the laboratory/organization performing the testing: 03/19/2024
The quantity of what the sample constitutes: 95T
A brief description of the sample: 3/4" Aggregate w 15% RAP
From where was the sample collected: Manufacturer
Laboratory sample identification: 2303191
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Sierra Pacific Materials Avenal
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-10-0006
The fabricator's/manufacturer's product name for the sample: 3/4" HMA-Rap
The fabricator/manufacturer designation for the sample:
The plant number: 39AC34ASA28
A detailed description of where the material sample was collected: Conveyor Belt
Where the material sample would have been placed if not sampled: Roadway
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number:
Lot number: 1
Sublot number: 3
Aggregate Mix Number:
Test Results
