Sample Record for 2025-10-30-65
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 212470 DEA: 044A1304 EFIS: 0400001106 COOP: 042718
QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-101-18.5/18.5
Work Description: CONSISTS OF MODIFICATION AND RECONSTRUCTION OF THE EXISTING US 101/HEARN AVENUE INTERCHANGE IN SONOMA COUNTY, INCLUDING REPLACING THE EXISTING TWO-LANE HEARN AVENUE OVERCROSSING WITH A NEW OVERCROSSING, AND MODIFYING THE SOUTHBOUND OFF-RAMP IN CITY
Location Description: IN SONOMA COUNTY.
Contractor Name: Ghilotti Construction Company, Inc. (Chase McPhaul)
Contractor Address: 246 Ghilotti Avenue, Santa Rosa, CA 95407
Resident Engineer: Seyed "Syd" Valeh Structure Rep.: Anthony "Tony" Tierra; Sardar Chalabe
Sample Information
DIME Sample ID: 2025-10-30-65
TL Number from the TL Form:
Sample Submitted By Organization: CT D04 - Petaluma Field Laboratory
Sample Organization Contact: (510) 385-6841
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 10/30/2025
Date that the sample was received by the laboratory/organization performing the testing: 10/30/2025
The quantity of what the sample constitutes: 3 bags
A brief description of the sample: 1/2 ham aggregates
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Bodean Mark West Quarry
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-49-0032
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: Hot Bins
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
