Sample Record for 2019-05-29-38
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 213728 DEA: 041K0104 EFIS: 0416000179
QA Service Level: 1
DIST-CO-RTE-PM: 04-NAP-121-0.0-0.3,2.0-R4.5
Work Description: COLD PLANE AC PAVEMENT AND PLACE RHMA-G.
Location Description: NAPA COUNTY IN AND NEAR NAPA FROM SONOMA COUNTY LINE TO 0.3 MILE NORTH OF SONOMA COUNTY LINE AND FROM DUHIG ROAD TO ROUTE 29
Contractor Name: GHILOTTI BROS., INC.
Contractor Address: 525 JACOBY STREET, SAN RAFAEL CA 94901
Resident Engineer: Fernando Dos Santos Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2019-05-29-38
TL Number from the TL Form: NA
Sample Submitted By Organization: CT D04 - Concord Field Laboratory
Sample Organization Contact: (510) 714-7019
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 05/29/2019
Date that the sample was received by the laboratory/organization performing the testing: 05/29/2019
The quantity of what the sample constitutes: 200 tons
A brief description of the sample: 1/2" HMA+RAP SP-WMA
From where was the sample collected: Manufacturer
Laboratory sample identification: Con_19_098
Structure unique identifier: 28-Napa
Structure name: NA
The fabricator/manufacturer/facility name: SYAR Lake Herman Drum
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-48-0002::LAKE HERMAN QUARRY
The fabricator's/manufacturer's product name for the sample: NA
The fabricator/manufacturer designation for the sample: NA
The plant number: NA
A detailed description of where the material sample was collected: Sampling point at the plant
Where the material sample would have been placed if not sampled: Roadway
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number: 3111015-LD 0119
Lot number: 1
Sublot number: 1
Aggregate Mix Number:
Test Results
