Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994819 DEA: 060U4304 EFIS: 0616000033
QA Service Level: 1
DIST-CO-RTE-PM: 06-KER-184-8.5/11.6
Work Description: RESURFACE LANES AND SHOULDERS.
Location Description: KERN COUNTY IN AND NEAR BAKERSFIELD FROM 0.1 MILE NORTH OF EDISON HIGHWAY TO 0.1 MILE NORTH OF CHASE AVENUE
Contractor Name: Griffith Company
Contractor Address: 1128 Carrier Parkway Avenue, Bakersfield CA 93308
Resident Engineer: Amrit Brar Structure Rep.: Unknown
DIME Sample ID: 2024-05-17-16
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Bakersfield Field Laboratory
Sample Organization Contact: 661-549-8281
Type of Sample: Department Acceptance
Type of Material: Aggregate
Sample Taken Date: 05/17/2024
Date that the sample was received by the laboratory/organization performing the testing: 05/17/2024
The quantity of what the sample constitutes: 2bags
A brief description of the sample: 3/4 HMA Type A
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Griffith Edmonston
Source Identification (SMARA, name of Pit or Job Site): 91-15-0068
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: coldfeed
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: 4
Aggregate Mix Number:
