Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 66666 DEA: APP EFIS: 0019000052
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for submitting Sample information for Aggregate Pre-approval Program (APP). Object Code: 1025. J2 DEA: 912680.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2020-10-07-41
TL Number from the TL Form: Twining Long Beach
Sample Submitted By Organization: Coast Aggregates
Sample Organization Contact: 714-393-3853
Type of Sample: Aggregate Prequalification Program
Type of Material: Aggregate
Sample Taken Date: 10/07/2020
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 10 5 gallon buckets of each material
A brief description of the sample: Split samples of 1", 3/8" & washed concrete sand
From where was the sample collected: Source
Laboratory sample identification: 1707511
Structure unique identifier:
Structure name: N / A
The fabricator/manufacturer/facility name: Coast Aggregates, Big Rock
Source Identification (SMARA, name of Pit or Job Site): 91-19-0054::BIG ROCK CREEK - LEBATA
The fabricator's/manufacturer's product name for the sample: Big Rock C33 Samples
The fabricator/manufacturer designation for the sample: Big Rock C33 Split Sample
The plant number: NA
A detailed description of where the material sample was collected: From stockpiles at source
Where the material sample would have been placed if not sampled: Loaded into Transportation Units
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number: NA
Lot number: 1
Sublot number: 1
Aggregate Mix Number:
