Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993815 DEA: 081C0814 EFIS: 0816000086
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-10-R60.7/R74.3
Work Description: I-10 PAVEMENT REHABILITATION (SEGMENT 1) PROJECT
Location Description: Coachella
Contractor Name: COFFMAN SPECIALTIES, INC
Contractor Address: 4375 JUTLAND DRIVE STE 260, SAN DIEGO CA 92117
Resident Engineer: Michael Sergah Structure Rep.: Al Alina
DIME Sample ID: 2023-05-11-32
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: 05/11/2023
Date that the sample was received by the laboratory/organization performing the testing: 05/15/2023
The quantity of what the sample constitutes: 3 Bags of Aggs each 3/4" and 1/2", 2 bags of 3/8" Aggs., 3 bags of Sand, 2 bags of RAP
A brief description of the sample: JMF 3/4" HMA-A-SP R24 0.5% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0255A-23
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Martin Marrietta - Coachella
Source Identification (SMARA, name of Pit or Job Site): 91-33-0084
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: Manufacturer
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: 43417155
Lot number:
Sublot number:
Aggregate Mix Number:
