Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 66666 DEA: APP EFIS: 0019000052
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for submitting Sample information for Aggregate Pre-approval Program (APP). Object Code: 1025. J2 DEA: 912680.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2020-01-17-14
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Aggregate Prequalification Program
Type of Material: Aggregate
Sample Taken Date: 01/17/2020
Date that the sample was received by the laboratory/organization performing the testing: 03/27/2020
The quantity of what the sample constitutes: 6 Bags
A brief description of the sample: Washed 1" x #4 Crushed Rock
From where was the sample collected: Source
Laboratory sample identification: 9669
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Corona
Source Identification (SMARA, name of Pit or Job Site): 91-33-0027::CORONA QUARRY
The fabricator's/manufacturer's product name for the sample: Unknown
The fabricator/manufacturer designation for the sample: Unknown
The plant number: Unknown
A detailed description of where the material sample was collected: Sampled at Stockpile
Where the material sample would have been placed if not sampled: Unknown
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number: Unknown
Lot number: Unknown
Sublot number: Unknown
Aggregate Mix Number:
