Sample Record for 2023-05-17-113
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 994248 DEA: 051K1204 EFIS: 0518000125
QA Service Level: 1
DIST-CO-RTE-PM: 05-SCR-9-1.0,4.0
Work Description: CONSTRUCT SIDEHILL VIADUCTS.
Location Description: SANTA CRUZ COUNTY AT 0.5 MILE NORTH OF VERNON STREET AND AT 0.8 MILE SOUTH OF GLENGARRY ROAD
Contractor Name: GORDON N BALL INC
Contractor Address: 333 CAMILLE AVENUE, ALAMO, CA 94507
Resident Engineer: Farshad Keshavarzi Structure Rep.: James Wilcenski
Sample Information
DIME Sample ID: 2023-05-17-113
TL Number from the TL Form:
Sample Submitted By Organization: RMA Group - Rancho Cordova
Sample Organization Contact: (916) 631-7194
Type of Sample: Quality Control
Type of Material: Aggregate
Sample Taken Date: 05/17/2023
Date that the sample was received by the laboratory/organization performing the testing: 05/18/2023
The quantity of what the sample constitutes: 1 Day
A brief description of the sample: 1x4 Aggregates
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Las Animas
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-35-0012
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: Plant
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
