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Sample Record for 2019-04-17-14

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

Project Information

Project ID: 210837 DEA: 080J0804 EFIS: 0800000283 COOP: 081625 QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-15-34.7/51.6
Work Description: (Alternative Delivery) DESIGN-BUILD OF THE INTERSTATE 15 EXPRESS LANES PROJECT
Location Description: Riverside County and SBD-15-0.0/1.3
Contractor Name: Skanska-Ames, Joint Venture
Contractor Address: 1801 California Avenue, Corona, CA 92881
Resident Engineer: Roy Fisher (reports) Structure Rep.: Roy Fisher

Sample Information

DIME Sample ID: 2019-04-17-14
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: Per Request
Type of Material: Aggregate
Sample Taken Date: 04/17/2019
Date that the sample was received by the laboratory/organization performing the testing: 04/17/2019
The quantity of what the sample constitutes: 1 bag
A brief description of the sample: Aggregate Subbase Recycled Asphalt
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Caltrans

Material Information

Source Identification (SMARA, name of Pit or Job Site): Unknown
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: I-15 NB
Where the material sample would have been placed if not sampled: Unknown
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: Unknown
Lot number: Unknown
Sublot number: Unknown
Aggregate Mix Number:

Test Results