Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000232 DEA: 09392304
QA Service Level: 1
DIST-CO-RTE-PM: 09-MNO-120,182-Var
Work Description: RECYCLE PAVEMENT, PLACE HMA, AND INSTALL GUARDRAIL.
Location Description: MONO COUNTY AT VARIOUS LOCATIONS
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2026-07-10-38
TL Number from the TL Form: 5479
Sample Submitted By Organization: CT D09 - Bishop Field Laboratory
Sample Organization Contact: (760) 872-5211
Type of Sample: Verification
Type of Material: Aggregate
Sample Taken Date: 07/10/2026
Date that the sample was received by the laboratory/organization performing the testing: 07/10/2026
The quantity of what the sample constitutes: JMF Re Verification Testing
A brief description of the sample: 1/2" Coldfeed & RAP
From where was the sample collected: Source
Laboratory sample identification: JMF RN 1
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Lee Vining Hot Plant
Source Identification (SMARA, name of Pit or Job Site): 91-26-0029
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: Sample Device on 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:
