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Sample Record for 2018-04-04-5

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 212740 DEA: 010H7004 EFIS: 0118000075 QA Service Level: 1
DIST-CO-RTE-PM: 01-DN-101-14.9/15.3, 14.8/15.1, 14.8/15.4
Work Description: Roadway stabilization & retaining wall repair
Location Description: In Del Norte County near Crescent City from 1.0 to 1.3 miles north of Rudsill Road
Contractor Name: STEWART ENGINEERING INC
Contractor Address: P O BOX 990010, REDDING CA 96099
Resident Engineer: Karen Sanders Structure Rep.: Gary Woodard

Sample Information

DIME Sample ID: 2018-04-04-5
TL Number from the TL Form: 928801
Sample Submitted By Organization: CT D01 - District 1 Materials Laboratory
Sample Organization Contact: (707) 496-0974
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 04/04/2018
Date that the sample was received by the laboratory/organization performing the testing: 04/13/2018
The quantity of what the sample constitutes: 750 Tons
A brief description of the sample: 0.5 HMA-A wRAP
From where was the sample collected: Manufacturer
Laboratory sample identification: 61918
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Tidewater Smith River

Material Information

Source Identification (SMARA, name of Pit or Job Site): 91-08-0002::HUFFMAN BAR
The fabricator's/manufacturer's product name for the sample: L160721
The fabricator/manufacturer designation for the sample: L160721
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