Sample Record for 2024-05-20-4
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 994864 DEA: 050N74U4 EFIS: 0522000025
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-9.9/10.6
Work Description: SB 101 4D North San Ysidro to Olive Mill
Location Description: In Santa Barbara County in and near Santa Barbara from 0.1 mile south of San Ysidro Road Overcrossing to 0.1 north of Olive Mill Road Overcrossing
Contractor Name: Craig Flowers (Granite Construction Company)
Contractor Address: PO Box 6744, Santa Barbara, CA 93160
Resident Engineer: Taylor Merlo Structure Rep.: Emiliano Berntsen
Sample Information
DIME Sample ID: 2024-05-20-4
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Carpinteria Field Laboratory
Sample Organization Contact: (805) 621-3616
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 05/20/2024
Date that the sample was received by the laboratory/organization performing the testing: 05/20/2024
The quantity of what the sample constitutes: 20 cy
A brief description of the sample: 1 x 4 PCC Aggregate
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CEMEX Santa Barbara
Material Information
Source Identification (SMARA, name of Pit or Job Site): HI Grade - Little Rock
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: Conveyor 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:
Test Results
