Sample Record for 2018-06-15-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 213121 DEA: 09373504 EFIS: 0918000003
QA Service Level: 1
DIST-CO-RTE-PM: 09-MNO-395-93.7/106.3
Work Description: CONSTRUCT HOT MIX ASPHALT OVER COLD IN-PLACE RECYCLED PAVEMENT.
Location Description: MONO COUNTY NEAR WALKER FROM ROUTE 108 TO EASTSIDE LANE
Contractor Name: ROAD AND HIGHWAY BUILDERS OF CALIFORNIA, INC.
Contractor Address: P.O. BOX 70846, Reno, NV 89570
Resident Engineer: Lee Scotese Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2018-06-15-1
TL Number from the TL Form:
Sample Submitted By Organization: CT D09 - Bishop Field Laboratory
Sample Organization Contact: (760) 872-5211
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 06/15/2018
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: sqyd
A brief description of the sample: pulverized roadway
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: road and highway
Material Information
Source Identification (SMARA, name of Pit or Job Site): N/A
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: STA 1075
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
