Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002130 DEA: 113A9454 EFIS: 1125000160
QA Service Level: 1
DIST-CO-RTE-PM: 11-UNKNOWN--unknown
Work Description: Ramp Pavement
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2026-04-21-45
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: Verification
Type of Material: Aggregate
Sample Taken Date: 04/21/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/22/2026
The quantity of what the sample constitutes: 5 bags
A brief description of the sample: JMFR
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Martin Marrietta Lake Elsinore
Source Identification (SMARA, name of Pit or Job Site): See Mix
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: 3/4 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number: 53417195
