Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994443 DEA: 053307C4 EFIS: 0514000028
QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO-41,46-44.5/45.3,54.0/57.8
Work Description: Wye Segment - Route 41/46 Separation
Location Description:
Contractor Name: Atkinson Construction
Contractor Address: 18201 Von Karman - Suite 800, Irvine, CA 92612
Resident Engineer: Brian Harrington Structure Rep.: Dave Lewis
DIME Sample ID: 2024-12-05-89
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Whitley Gardens Field Laboratory
Sample Organization Contact: 805-540-9933
Type of Sample: Dispute Resolution
Type of Material: Aggregate
Sample Taken Date: 12/05/2024
Date that the sample was received by the laboratory/organization performing the testing: 02/19/2025
The quantity of what the sample constitutes: 500-1000 cy
A brief description of the sample: Class 1 ASB - SPM- Avenal
From where was the sample collected: Job Site
Laboratory sample identification: 241205 Cl1ASB 2
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Sierra Pacific Materials - Avenal
Source Identification (SMARA, name of Pit or Job Site): 91-10-0006
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: Windrow
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1-1/2 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
