Sample Record for 2017-04-28-19
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 211733 DEA: 024E4204 EFIS: 0200020283
QA Service Level: 1
DIST-CO-RTE-PM: 02-LAS,SIE-70,395-3.5/3.9,R0.0/R3.1,R0.0/R5.6
Work Description: RHMA-GG,COLD PLANEAC,POLYESTER CONC OVERLAY,PCCAPPROACH SLABS,STRIPING
Location Description: LASSEN AND SIERRA COUNTIES AT VARIOUS LOCATIONS
Contractor Name: SIERRA NEVADA CONSTRUCTION
Contractor Address: 2055 E. Greg St., Sparks, NV 89431
Resident Engineer: John Yolton Structure Rep.: Jeff Rothgery
Sample Information
DIME Sample ID: 2017-04-28-19
TL Number from the TL Form: T101 C847392
Sample Submitted By Organization: CT D02 - Redding Northern Regional Laboratory
Sample Organization Contact: (530) 225-3194
Type of Sample: Acceptance
Type of Material: Job Mix Formula Partial
Sample Taken Date: 04/28/2017
Date that the sample was received by the laboratory/organization performing the testing: 04/28/2017
The quantity of what the sample constitutes: 13 bags 45lbs ea
A brief description of the sample: 19mm virgin bin stockpiles
From where was the sample collected: Manufacturer
Laboratory sample identification: D76904 17-02-S1
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: SNC Mustang
Material Information
Source Identification (SMARA, name of Pit or Job Site): unknown
The fabricator's/manufacturer's product name for the sample: 19mm Virgin agg bins
The fabricator/manufacturer designation for the sample: Unknown
The plant number: Unknown
A detailed description of where the material sample was collected: Plant
Where the material sample would have been placed if not sampled: Unknown
Superpave or Non-superpave Mix: Superpave
Test Results
