Sample Record for 2023-12-28-21
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214486 DEA: 080K1224 EFIS: 0815000244
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15-R28.6/37.5
Work Description: REHBILIATATE EXISTING MAINLINE AND RAMP PAVEMENT
Location Description: SAN BERNARDINO COUNTY IN HESPERIA AND VICTORVILLE FROM OAK HILL ROAD OVERCROSSING TO 0.1 MILE SOUTH OF BEAR VALLEY ROAD OVERCROSSING
Contractor Name: SULLY - MILLER CONTRACTING COMPANY
Contractor Address: 135 S STATE COLLEGE BLVD. 400, BREA, CA 92821
Resident Engineer: Larry J Canuti Structure Rep.: Taghreed Al-khateeb
Sample Information
DIME Sample ID: 2023-12-28-21
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Barstow Field Laboratory 1
Sample Organization Contact: (760) 252-9216
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 12/28/2023
Date that the sample was received by the laboratory/organization performing the testing: 12/29/2023
The quantity of what the sample constitutes: 1 bag
A brief description of the sample: Cold Feed 3/4" AC Aggregate
From where was the sample collected: Fabricator
Laboratory sample identification: test 1 a90CY AT0740 am
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Sully Miller
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-33-0068
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample: 3000222
The plant number:
A detailed description of where the material sample was collected: At the plant
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: 3
Sublot number: 42
Aggregate Mix Number:
Test Results
