Sample Record for 2024-08-13-119
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1000003 DEA: 024J8404 EFIS: 0223000079
QA Service Level: 1
DIST-CO-RTE-PM: 02-LAS-395-76.0/92.0
Work Description: ASPHALT RUBBER CHIP SEAL AND REPLACE ASPHALT CONCRETE SURFACING.
Location Description: LASSEN COUNTY NEAR LITCHFIELD FROM 0.1 MILE SOUTH OF MAPES LANE TO 0.1 MILE NORTH OF KARLO ROAD
Contractor Name: VSS INTERNATIONAL, INC.
Contractor Address: 3785 CHANNEL DRIVE, WEST SACRAMENTO, CA 95691
Resident Engineer: Daniel Gibbs Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2024-08-13-119
TL Number from the TL Form: 823618
Sample Submitted By Organization: CT D02 - Redding Northern Regional Laboratory
Sample Organization Contact: (530) 225-3194
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 08/13/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/19/2024
The quantity of what the sample constitutes: 1 bag
A brief description of the sample: 3/8" Pre-coated Chips
From where was the sample collected: Other
Laboratory sample identification: D79690
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Lockwood
Material Information
Source Identification (SMARA, name of Pit or Job Site): Lockwood Quarry (NV)
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: ?
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:
Test Results
