Sample Record for 2022-04-08-1
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 214993 DEA: 051F5004 EFIS: 0514000003
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101,135-70.6/71.2;0.1
Work Description: CONSTRUCT CONCRETE BRIDGE, BRIDGE REMOVAL, COLD PLANE, PLACE HMA.
Location Description: SANTA BARBARA COUNTY AT LOS ALAMOS ON ROUTE 101 FROM 0.3 MILE SOUTH TO 0.3 MILE NORTH OF ROUTE 101/135 SEPARATION AND ON ROUTE 135 AT ROUTE 101/135 SEPARATION
Contractor Name: CAL PORTLAND CONSTRUCTION
Contractor Address: 1625 E Donovan Road, Santa Maria, CA 93454
Resident Engineer: Jason Torres Structure Rep.: Alex Martinez
Sample Information
DIME Sample ID: 2022-04-08-1
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: 04/08/2022
Date that the sample was received by the laboratory/organization performing the testing: 04/08/2022
The quantity of what the sample constitutes: 1 days placement
A brief description of the sample: Concrete sand
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Calportland/Donaven
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-42-0014
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: Calportland Donaven plant
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: fine
The concrete mix design number: 590GM1060
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
