Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 88888 DEA: SMTL-STOCK EFIS: SMTL-STOCK
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for SMTL stock material. Object Code: 1025. J2 DEA: 912680.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2016-08-01-6
TL Number from the TL Form: na
Sample Submitted By Organization: CT HQ - Sacramento Aggregate Testing Laboratory
Sample Organization Contact: (915) 296-1892
Type of Sample: Proficiency
Type of Material: Aggregate
Sample Taken Date: 08/01/2016
Date that the sample was received by the laboratory/organization performing the testing: 07/11/2016
The quantity of what the sample constitutes: 1 box
A brief description of the sample: CCRL 1260 No.1
From where was the sample collected: Source
Laboratory sample identification: 16FPCC-0285
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CCRL
Source Identification (SMARA, name of Pit or Job Site): CCRL 1260 No 1
The fabricator's/manufacturer's product name for the sample: Unknown
The fabricator/manufacturer designation for the sample: Unknown
The plant number: Unknown
A detailed description of where the material sample was collected: Stockpile
Where the material sample would have been placed if not sampled: Unknown
Primary Aggregate Nominal Size: fine
The concrete mix design number: Unknown
Lot number:
Sublot number:
Aggregate Mix Number:
