Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 9999 DEA: 00000000 EFIS: 0000000000 COOP: 99999333399 MINOR: 333333 Permit Numbers: 555555 0400NRT0000
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC,OMG-888,99,80-0.6-0.6
Work Description: THIS PROJECT RECORD WAS ADDED FOR DIME DEVELOPERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Location Description: THIS PROJECT RECORD WAS ADDED FOR DIME DEVELOPERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Contractor Name: YYZ
Contractor Address: 1234 address, Sacramento, CA 95824
Resident Engineer: RE_first RE_last Structure Rep.: SR_First SR_Last
DIME Sample ID: 2026-05-19-6
TL Number from the TL Form:
Sample Submitted By Organization: Stonemont Solutions, Incorporated
Sample Organization Contact: (970) 674-1148
Type of Sample: Quality Control
Type of Material: Hot Mix Asphalt
Sample Taken Date: 05/19/2026
Date that the sample was received by the laboratory/organization performing the testing: 05/19/2026
The quantity of what the sample constitutes: 1000
A brief description of the sample: half inch HMA Type A
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Stonemont WIndsor Asphalt
DIME Test ID: 2026-05-19-6-1
Test Method: AASHTO T30-25: Standard Method of Test for Mechanical Analysis of Extracted Aggregate (Mechanical Analysis)
Submitted By Organization: Stonemont Solutions, Incorporated
Organization Address: 128 North 6th Street, Suite A,
Organization City: Windsor
Organization State: CO
Organization Zipcode: 80550
Organization Email: jbeal@stonemont.com
Organization Phone: (970) 674-1148
Data has not been verified.
