Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214921 DEA: 09367404 EFIS: 0916000025
QA Service Level: 1
DIST-CO-RTE-PM: 09-KER-14-R4.7/R12.6
Work Description: CONSTRUCT CRCP OVER EXISTING PAVEMENT AND PLACE HMA.
Location Description: KERN COUNTY AT AND NEAR ROSAMOND AND MOJAVE FROM 1.4 MILES SOUTH OF DAWN ROAD OVERCROSSING TO 0.5 MILE NORTH OF SILVER QUEEN ROAD OVERCROSSING
Contractor Name: Jesus Pena
Contractor Address: 18201 Von Karman, Suite #800, IRVINE CA 92612
Resident Engineer: Hin Hartanto Structure Rep.: Unknown
DIME Sample ID: 2021-07-02-11
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: Verification
Type of Material: Aggregate
Sample Taken Date: 07/02/2021
Date that the sample was received by the laboratory/organization performing the testing: 07/06/2021
The quantity of what the sample constitutes: 2 Bags Coldfeed Agg., 2 Bags Agg., 2 Bags Rap
A brief description of the sample: JMF 1/2" HMA-A-SP R25 0.8% Dry Lime
From where was the sample collected: Manufacturer
Laboratory sample identification: 0402A-21
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Construction Company Bigrock
Source Identification (SMARA, name of Pit or Job Site): 91-19-0046::BIG ROCK CREEK- GRANITE
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number: 1203
A detailed description of where the material sample was collected: Belt Cut at Granite Construction Company Big Rock
Where the material sample would have been placed if not sampled: Asphalt Paving
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
