Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000113 DEA: 060U5004 EFIS: 0615000300
QA Service Level: 1
DIST-CO-RTE-PM: 06-KER-5-10.2/16.0
Work Description: INDIVIDUAL SLAB REPLACEMENT (RSC), HMA (TYPE A) AND RHMA (GAP GRADED).
Location Description: KERN COUNTY AT AND NEAR WHEELER RIDGE FROM GRAPEVINE UNDERCROSSING TO ROUTE 5/99 SEPARATION
Contractor Name: Security Paving Company, Inc. (TJ Mattivi)
Contractor Address: Unknown
Resident Engineer: Robert Decker Structure Rep.: Albert Heredia
DIME Sample ID: 2025-05-29-12
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Bakersfield Field Laboratory
Sample Organization Contact: 661-549-8281
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 05/29/2025
Date that the sample was received by the laboratory/organization performing the testing: 05/30/2025
The quantity of what the sample constitutes: L1SL14
A brief description of the sample: 3/4 HMA Type A
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Solari
Source Identification (SMARA, name of Pit or Job Site): 91-15-0114
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: Cold Feed
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number:
Lot number: 1
Sublot number: 14
Aggregate Mix Number:
