Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 7 DEA: 010A0804 EFIS: 0100020017
QA Service Level: 1
DIST-CO-RTE-PM: 01-LAK-29,281-19.0/20.3,14.0/17.0
Work Description: BONDED WEARING COURSE USING WARM MIX ASPHALT TECHNOLOGY
Location Description: LAKE COUNTY NEAR LOWER LAKE ON ROUTE 29 FROM 1.3 MILES SOUTH TO 0.1 MILE SOUTH OF ROUTE 29/53 JUNCTION AND ON ROUTE 281 FROM 1.1 MILES WEST OF POINT LAKEVIEW ROAD TO ROUTE 29/281 JUNCTION
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: P O BOX 50085, WATSONVILLE, CA 95077-5085
Resident Engineer: SCOTT BAKER Structure Rep.: Unknown
DIME Sample ID: 2025-05-01-3
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Sample Organization Contact: (858) 285-5797
Type of Sample: Quality Control
Type of Material: Precast Concrete
Sample Taken Date: 05/01/2025
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 5
A brief description of the sample: cores
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: sfs
The concrete mix design number: 8999999
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 5555
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: 525555
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
