Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
DEA: No Project
QA Service Level:
DIST-CO-RTE-PM: ---
Work Description: Special project identifier for material not associated with a project
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2017-04-20-34
TL Number from the TL Form: Unknown
Sample Submitted By Organization: CT - Unassigned/General Field Laboratory
Sample Organization Contact: 5625005861
Type of Sample: Quality Control
Type of Material: Hot Mix Asphalt
Sample Taken Date: 04/20/2017
Date that the sample was received by the laboratory/organization performing the testing: 04/20/2017
The quantity of what the sample constitutes: Mix Design
A brief description of the sample: 1/2-inch Type A HMA, PG 64-16
From where was the sample collected: Other
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pavement Engineering Inc
