Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 4086 DEA: 07293304
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-5-17.2
Work Description: CONSTRUCT SLOPE PAVING WITH COBBLESTONE AT NORTH ABUTMENT OF HOLLENBECK LAKE BRIDGE ON RTE 5
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2022-02-22-23
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: 02/22/2022
Date that the sample was received by the laboratory/organization performing the testing: 03/01/2022
The quantity of what the sample constitutes: 1 bag (combined coarse and fine)
A brief description of the sample: Aggregate gradation
From where was the sample collected: Job Site
Laboratory sample identification: SRL
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Robertsons Rialto
Source Identification (SMARA, name of Pit or Job Site): native
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: 1
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: fine
The concrete mix design number: 19
Lot number: 5
Sublot number:
Aggregate Mix Number:
DIME Test ID: 2022-02-22-23-1
Test Method: AASHTO T11-5: Standard Method of Test for Materials Finer Than 75-μm (No. 200) Sieve in Mineral Aggregates by Washing
Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: (909) 829-3029
Data has not been verified.
