Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
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
DIME Sample ID: 2023-04-19-86
TL Number from the TL Form:
Sample Submitted By Organization: CT D04 - San Jose Construction Field Laboratory
Sample Organization Contact: (510) 385-8171
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 04/19/2023
Date that the sample was received by the laboratory/organization performing the testing: 04/19/2023
The quantity of what the sample constitutes: 4 boxes
A brief description of the sample: 3/4" RHMA-G
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Graniterock Aromas Batch plant
