Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000007 DEA: 061F8304 EFIS: 0623000101
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-180-43.5/53.6
Work Description: COLD PLANE AC PAVEMENT, RHMA-G (BWC) AND HMA (TYPE A).
Location Description: FRESNO COUNTY NEAR KERMAN FROM GOLDENROD AVENUE TO BRAWLEY AVENUE
Contractor Name: CAL VALLEY CONSTRUCTION, INC.
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2024-08-21-45
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Millbrook Field Laboratory
Sample Organization Contact: (559) 341-3953
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 08/21/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/21/2024
The quantity of what the sample constitutes: 1 bag of cold-feed
A brief description of the sample: 3/4 cold feed and rap
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Ashlan
Source Identification (SMARA, name of Pit or Job Site): 91-20-0016
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: 1
Sublot number: 3
Aggregate Mix Number:
