Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001111 DEA: 010M6504 EFIS: 0123000052
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-101-125.7/R131.7
Work Description: REPLACE AC SURFACING AND DELINEATION.
Location Description: HUMBOLDT COUNTY ON ROUTE 101 FROM 0.40 MILE SOUTH OF SOUTH PRAIRIE CREEK UNDERCROSSING TO 2.76 MILES NORTH OF BOYES CREEK VIADUCT
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2025-08-13-23
TL Number from the TL Form:
Sample Submitted By Organization: CT D01 - Crescent City Field Laboratory
Sample Organization Contact: (707) 496-5581
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 08/13/2025
Date that the sample was received by the laboratory/organization performing the testing: 08/13/2025
The quantity of what the sample constitutes: 2 bags agg
A brief description of the sample: sample at 1250 tons
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kernen Blue Lake Plant
Source Identification (SMARA, name of Pit or Job Site): kernen
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: plant
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:
