Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993612 DEA: 112N1184 EFIS: 1121000147
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-78-60.3/66.4
Work Description: COLD PLANE, RHMA-G OVERLAY, SHOULDER BACKING AND STRIPING.
Location Description: SAN DIEGO COUNTY NEAR JULIAN FROM WYNOLA ROAD TO 3.5 MILES WEST OF SAN FELIPE CREEK
Contractor Name: HANSON AGGREGATES PACIFIC SOUTHWEST LLC. DBA ATP GENERAL ENGINEERING CONTRAC
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2022-07-18-44
TL Number from the TL Form:
Sample Submitted By Organization: CT D11 - District 11 Materials Laboratory
Sample Organization Contact: (858) 518-8709
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 07/18/2022
Date that the sample was received by the laboratory/organization performing the testing: 07/26/2022
The quantity of what the sample constitutes: 12 boxes, 2 bags
A brief description of the sample: 1/2" RHMA-G
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CCA Lakeside
Source Identification (SMARA, name of Pit or Job Site): 91-37-0036
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: Plant
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
