Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994788 DEA: 061E5504 EFIS: 0622000064
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE,FRE/FRE-33,99-44.4/46.8
Work Description:
Location Description:
Contractor Name: Cal Valley Construction
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2023-05-22-23
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Millbrook Field Laboratory
Sample Organization Contact: (559) 341-3953
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 05/22/2023
Date that the sample was received by the laboratory/organization performing the testing: 05/23/2023
The quantity of what the sample constitutes: 750 tons
A brief description of the sample: 1/2 RHMA-O
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Madera
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: Conveyor Belt
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number:
Lot number: 3
Sublot number: 19
Aggregate Mix Number:
