Sample Record for 2019-03-22-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 210569 DEA: 083555V4 EFIS: 0814000086
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15-42.5/46.0
Work Description: WIDEN I-15, RECONSTRUCT 3 IC'S, CONSTRUCT 2 NEW BR AND WIDEN 3 BR.
Location Description: SAN BERNARDINO COUNTY IN VICTORVILLE FROM 0.5 MILE NORTH OF MOJAVE DRIVE TO 1.5 MILE NORTH OF STODDARD WELLS ROAD OVERCROSSING
Contractor Name: Ames Construction
Contractor Address: 2000 AMES DRIVE, BURNSVILLE, MN 55306
Resident Engineer: Taghreed Al-Khateeb Structure Rep.: Ravinder Singh
Sample Information
DIME Sample ID: 2019-03-22-1
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Aggregate Prequalification Program
Type of Material: Aggregate
Sample Taken Date: 03/22/2019
Date that the sample was received by the laboratory/organization performing the testing: 03/19/2019
The quantity of what the sample constitutes: 500
A brief description of the sample: 1" Max
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: abc
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-19-0021::BIG ROCK CREEK- VULCAN
The fabricator's/manufacturer's product name for the sample: Unknown
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 inch
The concrete mix design number: Unknown
Lot number: Unknown
Sublot number: Unknown
Aggregate Mix Number:
Test Results
