Sample Record for 2017-10-06-6
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 211954 DEA: 022H4804 EFIS: 0216000106
QA Service Level: 1
DIST-CO-RTE-PM: 02-TRI-36-R3.5/R9.2
Work Description: COLD IN-PLACE RECYCLE WITH HOT MIX ASPHALT OVERLAY AND GUARDRAIL
Location Description: TRINITY COUNTY NEAR MAD RIVER FROM 0.1 MILE EAST OF MAD RIVER ROAD TO 0.1 MILE WEST OF SOUTH FORK MOUNTAIN ROAD
Contractor Name: TULLIS INC
Contractor Address: P O BOX 493416, REDDING CA 96049
Resident Engineer: Sergio Mendoza Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2017-10-06-6
TL Number from the TL Form: T101 C852081
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: 10/06/2017
Date that the sample was received by the laboratory/organization performing the testing: 10/06/2017
The quantity of what the sample constitutes: 1 bag each bin 40 lbs each
A brief description of the sample: 1/2 Cold Feed and Rap
From where was the sample collected: Manufacturer
Laboratory sample identification: D77199
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Tullis Northstate Asphalt
Material Information
Source Identification (SMARA, name of Pit or Job Site): Unknown
The fabricator's/manufacturer's product name for the sample: Cold feed and rap
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
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number: Unknown
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
