Sample Record for 2022-04-05-8
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 213707 DEA: 081C38U4 EFIS: 0817000196
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-10-6.7/R25.1
Work Description: Remove concrete pavement and base, and place HMA and JPCP
Location Description: ROUTE 10/60 SEPARATION IN BEAUMONT TO ROUTE 10/111 SEPARATION NEAR CABAZON.
Contractor Name: Coffman Specialties
Contractor Address: 9685 Via Excelencia, San Diego, CA 92126
Resident Engineer: Elvira Lenart Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2022-04-05-8
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: 04/05/2022
Date that the sample was received by the laboratory/organization performing the testing: 04/07/2022
The quantity of what the sample constitutes: 4 Bags Of Aggregate, 1 Bag Rap
A brief description of the sample: Correction Factor, 3/4" HMA-A-SP R24 0.5% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0213A-22
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: California Commercial Asphalt - Coachella
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-33-0084
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number: 43417615
A detailed description of where the material sample was collected: Belt Cut at California Commercial Asphalt Coachella
Where the material sample would have been placed if not sampled: Asphalt Paving
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
