Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 211418 DEA: 051F9304 MINOR: 05A1829
QA Service Level: 1
DIST-CO-RTE-PM: 05-SBT-101-4.9/R7.9
Work Description:
Location Description: SBT County
Contractor Name: ARROW FENCING
Contractor Address: P.O. BOX 385, CALPELLA, CA 95418
Resident Engineer: Santiago Garcia Structure Rep.: Unknown
DIME Sample ID: 2025-09-04-5
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Millbrook Field Laboratory
Sample Organization Contact: (559) 341-3953
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 09/04/2025
Date that the sample was received by the laboratory/organization performing the testing: 09/04/2025
The quantity of what the sample constitutes: 115 TONS
A brief description of the sample: 3/4 HMA AGGREGATES
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Colinga
Source Identification (SMARA, name of Pit or Job Site): 91-10-0005
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: Conveyor Belt
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: 3
Aggregate Mix Number:
