Sample Record for 2022-07-01-33
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 993535 DEA: 081M1104 EFIS: 0821000078
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-215-10.0/17.2
Work Description: HMA, COLD PLANE AC PAVEMENT, AND TRAFFIC STRIPE TAPE.
Location Description: SAN BERNARDINO COUNTY?FROM 0.1 MILE NORTH OF 27TH STREET TO 0.1 MILE SOUTH OF DEVORE ROAD
Contractor Name: CALMEX ENGINEERING INC.
Contractor Address: 2764 S VISTA AVE, BLOOMINGTON, CA 92316
Resident Engineer: VuThanh Nguyen Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2022-07-01-33
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: Verification
Type of Material: Aggregate
Sample Taken Date: 07/01/2022
Date that the sample was received by the laboratory/organization performing the testing: 07/11/2022
The quantity of what the sample constitutes: 4 Bags Belt Cut Agg.,
A brief description of the sample: JMF 3/4" HMA-A-SP 0.50% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0440A-22
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan-San Bernardino Portable
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-19-0035, 91-36-0107
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number: 224108 SBP SJR
A detailed description of where the material sample was collected: Belt Cut at Vulcan Materials-San Bernardino
Where the material sample would have been placed if not sampled: Asphalt Paving
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
