Sample Record for 2026-05-04-67
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 993454 DEA: 040K8004 EFIS: 0416000141 COOP: 042892
QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN-101-13.7
Work Description: CONSTRUCT ROUNDABOUT, CURB RAMPS AND SW, SIGNAL AND LIGHTING SYSTEMS.
Location Description: MARIN COUNTY IN SAN RAFAEL AT FREITAS PARKWAY OVERCROSSING
Contractor Name: GHILOTTI BROS., INC.
Contractor Address: 525 JACOBY STREET, SAN RAFAEL CA 94901
Resident Engineer: Dawit Habteselassie Structure Rep.: Jeremy Light
Sample Information
DIME Sample ID: 2026-05-04-67
TL Number from the TL Form: C2026-05-04-01
Sample Submitted By Organization: CT D04 - Hayward DME / District Laboratory
Sample Organization Contact: (510) 507-3456
Type of Sample: Production Start-Up
Type of Material: Aggregate
Sample Taken Date: 05/04/2026
Date that the sample was received by the laboratory/organization performing the testing: 05/08/2026
The quantity of what the sample constitutes: 3 Bags Combined Aggregate
A brief description of the sample: 3/4" HMA-A
From where was the sample collected: Supplier
Laboratory sample identification: D04-SE-26-011
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Dutra San Rafael
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-21-0008
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: L1 SL1 PSU
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: 1
Aggregate Mix Number: L210143WMA
Test Results
