Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994976 DEA: 060X3304 EFIS: 0618000055
QA Service Level: 1
DIST-CO-RTE-PM: 06-KER-5-R0.0/4.4
Work Description: REPLACE ROADWAY PAVEMENT WITH HMA AND CONCRETE.
Location Description: KERN COUNTY AT AND NEAR LEBEC FROM LOS ANGELES COUNTY LINE TO GRAPEVINE CREEK
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: Unknown
Resident Engineer: Joy Denny Structure Rep.: Travis Landas
DIME Sample ID: 2024-08-15-25
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Bakersfield Field Laboratory
Sample Organization Contact: 661-549-8281
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 08/15/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/16/2024
The quantity of what the sample constitutes: L1SL15 2 bags aggregate and 1 bag RAP
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: Granite Solari
Source Identification (SMARA, name of Pit or Job Site): 91-15-0114
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: HMA Plant Cold Feed
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: 1
Sublot number: 15
Aggregate Mix Number:
