Sample Record for 2020-05-11-34
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 213707 DEA: 081C38U4 EFIS: 0817000196
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-10-6.7/R25.1
Work Description: Remove concrete pavement and base, and place HMA and JPCP
Location Description: ROUTE 10/60 SEPARATION IN BEAUMONT TO ROUTE 10/111 SEPARATION NEAR CABAZON.
Contractor Name: Coffman Specialties
Contractor Address: 9685 Via Excelencia, San Diego, CA 92126
Resident Engineer: Elvira Lenart Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2020-05-11-34
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Sample Organization Contact: 9512323690
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 05/11/2020
Date that the sample was received by the laboratory/organization performing the testing: 05/11/2020
The quantity of what the sample constitutes: 4 bags
A brief description of the sample: 3/4 Type A HMA
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: California Commercial Asphalt - Coachella
Material Information
Source Identification (SMARA, name of Pit or Job Site): cca
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: Intercepting discharged into the weigh hopper
Where the material sample would have been placed if not sampled: Unknown
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: 43417615
Lot number: Unknown
Sublot number: Unknown
Aggregate Mix Number:
Test Results
