Sample Record for 2023-05-10-40
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214337 DEA: 080E33U4 EFIS: 0817000075
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-115-R7.3/R10.0
Work Description: ADD WB AUX & EB DECEL LANES, WIDEN I15 SW CONNECT,RAMPS/BRDG
Location Description: SAN BERNARDINO COUNTY IN ONTARIO FROM 0.2 MILE WEST OF CUCAMONGA CREEK BRIDGE TO MILLIKEN AVENUE
Contractor Name: Ames Construction
Contractor Address: 391 North Main Street, Suite 302, Corona, CA 92880
Resident Engineer: Denise Sostrom Structure Rep.: Matt Bruce
Sample Information
DIME Sample ID: 2023-05-10-40
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: 05/10/2023
Date that the sample was received by the laboratory/organization performing the testing: 05/16/2023
The quantity of what the sample constitutes: 2 Bags of Agg., 1 Bag of RAP
A brief description of the sample: PSUE 3/4" HMA-A-SP R15 NO LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0256A-23
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA- Corona
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-33-0005
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: 105927
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
