Sample Record for 2021-12-03-16
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 215129 DEA: 050N73U4 EFIS: 0520000166
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-7.3/9.6
Work Description: !!Please CC Office Engineer Gabrielle Herrera on reports to RE and SR!! Segment 4C - Summerland: Construct HOV lanes and rehabilitation. Source inspection of sign structure trusses, lighting structures, steel soldier piles, epoxy coated rebar,
Location Description: SUMMERLAND FROM 0.2 MILES NORTH OF PARDARO LANE OVERCROSSING TO SAN YSIDRO CREEK BRIDGE
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: PO Box 6744, Santa Barbara , CA 93111
Resident Engineer: Luobao Cai Structure Rep.: Emiliano Berntsen
Sample Information
DIME Sample ID: 2021-12-03-16
TL Number from the TL Form:
Sample Submitted By Organization: TRC Companies
Sample Organization Contact: (805) 621-3616
Type of Sample: Quality Control
Type of Material: Aggregate
Sample Taken Date: 12/03/2021
Date that the sample was received by the laboratory/organization performing the testing: 12/03/2021
The quantity of what the sample constitutes: 70 yards
A brief description of the sample: PCC Aggregates
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Martin Marietta
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-37-0039
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: Conveyor Belt
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: 725A1Z0P
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
