Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001174 DEA: 040X7004 EFIS: 0424000158
QA Service Level: 1
DIST-CO-RTE-PM: 04-SOL-84-3.0/13.6
Work Description: COLD PLANE AC PAVEMENT AND OVERLAY WITH RHMA-G (BWC).
Location Description: SOLANO COUNTY NEAR RIO VISTA FROM 0.4 MILE NORTH OF CACHE SLOUGH FERRY TO YOLO COUNTY LINE
Contractor Name: O.C. JONES & SONS, INC.
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2025-09-03-83
TL Number from the TL Form: CON-090325-1
Sample Submitted By Organization: CT D04 - Hayward DME / District Laboratory
Sample Organization Contact: (510) 507-3456
Type of Sample: Production Start-Up
Type of Material: Aggregate
Sample Taken Date: 09/03/2025
Date that the sample was received by the laboratory/organization performing the testing: 09/26/2025
The quantity of what the sample constitutes: 2 Bags per bin#1-4
A brief description of the sample: 3/4" HMA + 15% RAP
From where was the sample collected: Manufacturer
Laboratory sample identification: D04-SE-25-064
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Perkins - Continuous Plant
Source Identification (SMARA, name of Pit or Job Site): 91-34-0053
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: Stockpile @ 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:
Sublot number:
Aggregate Mix Number: 30140432407V
