Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 66667 DEA: JMFPP EFIS: 0019000043
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for submitting Sample information for JMF Prequalification Program.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2020-04-01-23
TL Number from the TL Form:
Sample Submitted By Organization: Gallagher and Burk Materials
Sample Organization Contact: (510) 421-2282
Type of Sample: Aggregate Prequalification Program
Type of Material: Aggregate
Sample Taken Date: 04/01/2020
Date that the sample was received by the laboratory/organization performing the testing: 04/01/2020
The quantity of what the sample constitutes: 20000 tons
A brief description of the sample: 1/2" Cold feed
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: DeSilva Gates Aggregates
Source Identification (SMARA, name of Pit or Job Site): 91-01-0007::SUNOL
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: Feeder Conveyor Belt
Where the material sample would have been placed if not sampled: Unknown
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number: Unknown
Lot number: Unknown
Sublot number: Unknown
Aggregate Mix Number:
