Sample Record for 2020-06-30-18
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 213551 DEA: 080K2934 EFIS: 0812000100
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-10-R36.8/R39.2
Work Description: PAVEMENT REHABILITATION AND CONTINUOUSLY REINFORCED CONCRETE PAVEMENT
Location Description: SAN BERNARDINO COUNTY IN YUCAIPA FROM 0.2 MILE WEST OF LIVE OAK CANYON ROAD TO COUNTY LINE ROAD UNDERCROSSING
Contractor Name: Coffman Specialties
Contractor Address: 9685 Via Excelencia, San Diego, CA 92126
Resident Engineer: Ezz Gayed Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2020-06-30-18
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Sample Organization Contact: 9512323690
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 06/30/2020
Date that the sample was received by the laboratory/organization performing the testing: 07/01/2020
The quantity of what the sample constitutes: 217
A brief description of the sample: AC Drum Aggregate
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Matich-Lytle Creek
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-36-0040::LYTLE CREEK
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: belt an chute
Where the material sample would have been placed if not sampled: Unknown
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: CHP-62D
Lot number: Unknown
Sublot number: Unknown
Aggregate Mix Number:
Test Results
