Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995468 DEA: 114B0084 EFIS: 1122000208
QA Service Level: 1
DIST-CO-RTE-PM: 11---
Work Description:
Location Description:
Contractor Name: Rubbia Khan Griffith COmpany
Contractor Address: 3050 East Birch Street, Brea, CA, 92821
Resident Engineer: Alfredo Hernandez Medina Structure Rep.: Unknown
DIME Sample ID: 2025-12-17-32
TL Number from the TL Form:
Sample Submitted By Organization: CT D11 - District 11 Materials Laboratory
Sample Organization Contact: (858) 518-8709
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 12/17/2025
Date that the sample was received by the laboratory/organization performing the testing: 12/19/2025
The quantity of what the sample constitutes: 1 bag
A brief description of the sample: Plant Sample
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Martin Marietta
Source Identification (SMARA, name of Pit or Job Site): Not Provided
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: 21217105 MM
DIME Test ID: 2025-12-17-32-1
Test Method: AASHTO T176-08: Standard Method of Test for Plastic Fines in Graded Aggregates and Soils by Use of the Sand Equivalent Test (Sand Equivalent)
Submitted By Organization: CT D11 - District 11 Materials Laboratory
Organization Address: 4050 Taylor Street,
Organization City: San Diego
Organization State: CA
Organization Zipcode: 92110
Organization Email: benjamin.haney@dot.ca.gov
Organization Phone: (858) 688-1595
Data has not been verified.
DIME Test ID: 2025-12-17-32-2
Test Method: AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)
Submitted By Organization: CT D11 - District 11 Materials Laboratory
Organization Address: 4050 Taylor Street,
Organization City: San Diego
Organization State: CA
Organization Zipcode: 92110
Organization Email: benjamin.haney@dot.ca.gov
Organization Phone: (858) 688-1595
Data has not been verified.
