Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993236 DEA: 051K0504 EFIS: 0518000114
QA Service Level: 1
DIST-CO-RTE-PM: 05-MON-1-55.7/55.9
Work Description: CONSTRUCT EARTH RETAINING SYSTEM WITH CIDH PILE & STRUCTURAL CONCRETE.
Location Description: MONTEREY COUNTY NEAR LITTLE SUR RIVER FROM 0.4 MILE SOUTH OF LITTLE SUR RIVER BRIDGE TO 0.2 MILE SOUTH OF LITTLE SUR RIVER BRIDGE
Contractor Name: GORDON N BALL INC
Contractor Address: 333 CAMILLE AVENUE, ALAMO CA 94507
Resident Engineer: Arashdeep (Art) Pannu Structure Rep.: David Galarza
DIME Sample ID: 2022-03-04-15
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Prunedale Field Laboratory
Sample Organization Contact:
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 03/04/2022
Date that the sample was received by the laboratory/organization performing the testing: 03/04/2022
The quantity of what the sample constitutes: 1 day of production
A brief description of the sample: 1x4 and WCS
From where was the sample collected: Other
Laboratory sample identification: 0309221240
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Las Animas, Marina CA
Source Identification (SMARA, name of Pit or Job Site): 91-35-0012::A.R. WILSON QUARRY
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: conveyor belt Las Animas
Where the material sample would have been placed if not sampled: CIDH Piles
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: M779PR50S
Lot number:
Sublot number:
Aggregate Mix Number:
