Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994051 DEA: 041Q5814 EFIS: 0421000262
QA Service Level: 1
DIST-CO-RTE-PM: 04-SM-101-0.0-6.5
Work Description: REHABILITATE PAVEMENT AND UPGRADE MEDIAN BARRIER [PS&E E-COPY AVAILABLE UPON REQUEST]
Location Description: SAN MATEO COUNTY FROM SAN MATEO COUNTY LINE IN EAST PALO ALTO TO WHIPPLE AVENUE IN REDWOOD CITY
Contractor Name: BAY CITIES PAVING & GRADING, INC.
Contractor Address: Unknown
Resident Engineer: Ethan Malonzo Structure Rep.: Unknown
DIME Sample ID: 2024-07-08-66
TL Number from the TL Form:
Sample Submitted By Organization: CT D04 - Hayward Field Laboratory
Sample Organization Contact: (510) 723-0168
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 07/08/2024
Date that the sample was received by the laboratory/organization performing the testing: 07/09/2024
The quantity of what the sample constitutes: 0-750Tons
A brief description of the sample: 1/2 RHMA-G
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Materials Co - Pleasanton
Source Identification (SMARA, name of Pit or Job Site): 91-01-0010
The fabricator's/manufacturer's product name for the sample: MD 326122
The fabricator/manufacturer designation for the sample: Sample # 1
The plant number:
A detailed description of where the material sample was collected: Plant Sampler
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number: D04-JMF-22-041
Lot number:
Sublot number:
Aggregate Mix Number:
