Sample Record for 2025-07-18-62
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 995174 DEA: 043W5604 EFIS: 0421000388
QA Service Level: 1
DIST-CO-RTE-PM: 04-SOL-12,80,680-Var
Work Description: POLYESTER CONCRETE OVERLAY.
Location Description: SOLANO COUNTY AT VARIOUS LOCATIONS
Contractor Name: MYERS & SONS CONSTRUCTION, LLC
Contractor Address: 45 Morrison ave, Sacramento, CA 95838
Resident Engineer: Justen Tatum Structure Rep.: Kambiz Kouchesfahani
Sample Information
DIME Sample ID: 2025-07-18-62
TL Number from the TL Form:
Sample Submitted By Organization: CT D04 - Concord Field Laboratory
Sample Organization Contact: (510) 714-7019
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 07/18/2025
Date that the sample was received by the laboratory/organization performing the testing: 07/09/2025
The quantity of what the sample constitutes: 100Tons
A brief description of the sample: 3/4"HMA-R25-WMA
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Napa
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-49-0004
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: At the plant
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: 11
Aggregate Mix Number:
Test Results
