Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994399 DEA: 09378704 EFIS: 0919000001
QA Service Level: 1
DIST-CO-RTE-PM: 09-MNO-395-55.5/58.2
Work Description: PARTIAL DEPTH RECYCLE AND HMA (TYPE A).
Location Description: MONO COUNTY NEAR LEE VINING FROM 0.2 MILE SOUTH OF CEMETERY ROAD TO ROUTE 167
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: Unknown
Resident Engineer: David Carruba Structure Rep.: Unknown
DIME Sample ID: 2023-08-01-22
TL Number from the TL Form:
Sample Submitted By Organization: CT D09 - Bishop Field Laboratory
Sample Organization Contact: (760) 872-5211
Type of Sample: Department Acceptance
Type of Material: Aggregate
Sample Taken Date: 08/01/2023
Date that the sample was received by the laboratory/organization performing the testing: 08/01/2023
The quantity of what the sample constitutes: 1 Bag of Coldfeed & 1 Bag of RAP
A brief description of the sample: 3/4" Coldfeed / RAP
From where was the sample collected: Source
Laboratory sample identification: CF-15 _ RAP-15
Structure unique identifier:
Structure name: Hwy 395 / Cemetery Rd
The fabricator/manufacturer/facility name: Granite Lee Vining
Source Identification (SMARA, name of Pit or Job Site): Granite Lee Vining
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: Feed Belt
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
