Sample Record for 2022-11-02-21
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 215753 DEA: 050N72U4 EFIS: 0520000169
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-4.4/R7.7
Work Description: Please cc Office Engineer Ni Nyoman Paul on reports sent to RE and SR. Construct High Occupancy Vehicle (HOV) lanes on U.S. Route 101 and rehabilitation - Segment 4B.
Location Description: 101 freeway in Summerland, CA
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 5335 Debbie Road, Santa Barbara, CA 93111
Resident Engineer: Luobao Cai Structure Rep.: Emiliano Berntsen
Sample Information
DIME Sample ID: 2022-11-02-21
TL Number from the TL Form:
Sample Submitted By Organization: TRC Companies
Sample Organization Contact: (805) 621-3616
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 11/02/2022
Date that the sample was received by the laboratory/organization performing the testing: 11/02/2022
The quantity of what the sample constitutes: 10 yards
A brief description of the sample: PCC Aggregates
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Martin Marietta Goleta
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 at Plant
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: fine
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
