Sample Record for 2025-08-11-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1000943 DEA: 09404304 EFIS: 0924000070
QA Service Level: 1
DIST-CO-RTE-PM: 09-MNO-120-32.1/R35.0,48.0/50.0
Work Description: COLD IN-PLACE RECYCLE EXISTING PAVEMENT AND PLACE HMA.
Location Description: MONO COUNTY NEAR BENTON FROM 0.5 MILE EAST TO 3.4 MILES EAST OF BAXTER\\\\'S ROAD AND FROM 2.0 MILES WEST OF BLACK LAKE ROAD TO BLACK LAKE ROAD
Contractor Name: PAPICH CONSTRUCTION COMPANY, INC.
Contractor Address: 398 Sunrise Terrace, Arroyo Grande, CA 93420
Resident Engineer: Malissa Reynolds Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2025-08-11-1
TL Number from the TL Form:
Sample Submitted By Organization: CT D09 - Bishop Field Laboratory
Sample Organization Contact: (760) 872-5211
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 08/11/2025
Date that the sample was received by the laboratory/organization performing the testing: 08/11/2025
The quantity of what the sample constitutes: 1 Bag of Shoulder Backing
A brief description of the sample: 1/2 agg base
From where was the sample collected: Job Site
Laboratory sample identification: SB-1
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Grinding Rock - Independence
Material Information
Source Identification (SMARA, name of Pit or Job Site): Grinding Rock - Pit Source
The fabricator's/manufacturer's product name for the sample: 66 - Shoulder Backing
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Stockpile on site
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
