Sample Record for 2023-01-19-58
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214986 DEA: 041J9704 EFIS: 0414000404
QA Service Level: 1
DIST-CO-RTE-PM: 04-SCL-17-2.8/13.94
Work Description: PAVING WITH RHMA, COLD PLANE AC, AND INSTALL CULVERT.
Location Description: SANTA CLARA COUNTY IN AND NEAR LOS GATOS, CAMPBELL AND SAN JOSE FROM HEBARD ROAD TO ROUTE 17/280 SEPARATION
Contractor Name: GRANITE ROCK COMPANY
Contractor Address: 120 Granite Rock, San Jose, CA 95136
Resident Engineer: Ali Nikzad Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2023-01-19-58
TL Number from the TL Form: C927702
Sample Submitted By Organization: CT D04 - San Jose Construction Field Laboratory
Sample Organization Contact: (510) 385-8171
Type of Sample: Annual Source Testing
Type of Material: Aggregate
Sample Taken Date: 01/19/2023
Date that the sample was received by the laboratory/organization performing the testing: 01/19/2023
The quantity of what the sample constitutes: 10 Bags
A brief description of the sample: 3/8"x #8
From where was the sample collected: Source
Laboratory sample identification: SJ-012023-PCC
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Los Banos TRP (Vulcan)
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-24-0009
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 Stockpile
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/8 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
