Sample Record for 2021-12-07-20
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 215785 DEA: 051H8504 EFIS: 0517000001
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB,SLO-101-70.7/91.0, 4.7/5.0
Work Description: CONSTRUCT CONTRASTING SURFACE TREATMENT AND GORE AREA PAVING.
Location Description: SANTA BARBARA AND SAN LUIS OBISPO COUNTIES NEAR SANTA MARIA AT VARIOUS LOCATIONS FROM ROUTE 135 TO WEST TEFFT STREET
Contractor Name: A.M. CONCRETE, INC
Contractor Address: Unknown
Resident Engineer: Patrick Stimson Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2021-12-07-20
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Santa Maria Field Laboratory
Sample Organization Contact:
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 12/07/2021
Date that the sample was received by the laboratory/organization performing the testing: 01/05/2022
The quantity of what the sample constitutes: 1 days placement
A brief description of the sample: 3/4" Recycled class 2 AB
From where was the sample collected: Job Site
Laboratory sample identification: 334
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Rock
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-42-0006::BEE ROCK QUARRY
The fabricator's/manufacturer's product name for the sample: 3/4 inch Recycled base
The fabricator/manufacturer designation for the sample: 3/4 in Class 2 Aggregate Base
The plant number:
A detailed description of where the material sample was collected: Stockpile on Jobsit
Where the material sample would have been placed if not sampled: Gore area
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
