Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000912 DEA: 061G7704 EFIS: 0624000165
QA Service Level: 1
DIST-CO-RTE-PM: 06-KIN-5-16.6/26.7
Work Description: REMOVE AND REPLACE ASPHALT CONCRETE OVERLAY.
Location Description: KINGS COUNTY IN AND NEAR AVENAL FROM ROUTE 5/41 SEPARATION TO FRESNO COUNTY LINE
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: Unknown
Resident Engineer: Chantha Chap Structure Rep.: Unknown
DIME Sample ID: 2025-10-26-6
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Millbrook Field Laboratory
Sample Organization Contact: (559) 341-3953
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 10/26/2025
Date that the sample was received by the laboratory/organization performing the testing: 10/27/2025
The quantity of what the sample constitutes: 0-750 Tons Produced
A brief description of the sample: 3/4” HMA Aggregate
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Coalinga
Source Identification (SMARA, name of Pit or Job Site): Granite Coalinga
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: Automatic Sampling Device @ 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: 7
Aggregate Mix Number:
