Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994330 DEA: 09366404 EFIS: 0916000006
QA Service Level: 1
DIST-CO-RTE-PM: 09-MNO-395-58.2/60.4
Work Description: HOT MIX ASPHALT (TYPE A), IMPORTED BORROW, AND ROADWAY EXCAVATION.
Location Description: MONO COUNTY ABOUT 6 MILES NORTH OF LEE VINING FROM ROUTE 167 TO 0.4 MILE NORTH OF CONWAY RANCH ROAD
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 500 South Main Street, Bishop, CA 93514
Resident Engineer: David Carruba Structure Rep.: Unknown
DIME Sample ID: 2024-07-01-1
TL Number from the TL Form:
Sample Submitted By Organization: CT D09 - Bishop Field Laboratory
Sample Organization Contact: (760) 872-5211
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 07/01/2024
Date that the sample was received by the laboratory/organization performing the testing: 07/01/2024
The quantity of what the sample constitutes: 2 Bags 3/8" Coldfeed, 1 bag of RAP
A brief description of the sample: 3/8" coldfeed
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name: Hwy 395 / Conway Ranch
The fabricator/manufacturer/facility name: Granite Lee Vining
Source Identification (SMARA, name of Pit or Job Site): Granite Lee Vining
The fabricator's/manufacturer's product name for the sample: 3/8" HMA-SP SJR 58-34M R15
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Cold Feed Sampling Chute
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/8 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
