Sample Record for 2026-09-27-2
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1001568 DEA: 033H51U4 EFIS: 0325000094
QA Service Level: 1
DIST-CO-RTE-PM: 03-NEV-49-R10.3/R13.8
Work Description: RDWY EXCAVATION, PLACE HMA, TRENCHLESS CULVERTS, AND RETAINING WALLS.
Location Description: NEVADA COUNTY NEAR GRASS VALLEY FROM 0.2 MILE SOUTH OF LA BARR MEADOWS ROAD TO 0.1 MILE NORTH OF SOUTH GRASS VALLEY OVERCROSSING
Contractor Name: GRANITE CONSTRUCTION
Contractor Address: 4001 BRADSHAW ROAD, SACRAMENTO, CA 95827
Resident Engineer: Renee Plaza Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2026-09-27-2
TL Number from the TL Form:
Sample Submitted By Organization: NV5 - Nevada City
Sample Organization Contact: (530) 362-0173
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 09/27/2026
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 1 bucket (5 gallon)
A brief description of the sample: 3/4" recycled aggregate base rock
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Hansen Brothers
Material Information
Source Identification (SMARA, name of Pit or Job Site): Jobsite
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: Windrow sta. 185+50
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:
Test Results
