Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994895 DEA: 060X2804 EFIS: 0618000049
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-5-60.1/66.2
Work Description: COLD PLANE EXISTING PAVEMENT AND RESURFACE WITH HMA AND RHMA.
Location Description: FRESNO COUNTY ABOUT 21 MILES WEST OF MENDOTA FROM SHIELDS AVENUE OVERCROSSING TO MERCED COUNTY LINE
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: Unknown
Resident Engineer: Haidar Haddadin Structure Rep.: Unknown
DIME Sample ID: 2024-06-24-18
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Millbrook Field Laboratory
Sample Organization Contact: (559) 341-3953
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 06/24/2024
Date that the sample was received by the laboratory/organization performing the testing: 06/24/2024
The quantity of what the sample constitutes: 848T
A brief description of the sample: 3/4" coldfeed
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Coalinga
Source Identification (SMARA, name of Pit or Job Site): 91-10-0005
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: Diverter Chute
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: 8
Aggregate Mix Number:
