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: 2021-05-12-11
TL Number from the TL Form:
Sample Submitted By Organization: California Nevada Cement Association
Sample Organization Contact: (520) 235-0480
Type of Sample: Informational
Type of Material: Aggregate
Sample Taken Date: 05/12/2021
Date that the sample was received by the laboratory/organization performing the testing: 05/12/2021
The quantity of what the sample constitutes: 1 rock
A brief description of the sample: a rock
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: California Nevada Cement Association
Source Identification (SMARA, name of Pit or Job Site): 99999999
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: a pile
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
