Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 66667 DEA: JMFPP EFIS: 0019000043
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for submitting Sample information for JMF Prequalification Program.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2022-01-06-59
TL Number from the TL Form:
Sample Submitted By Organization: Granite Construction Company - Fresno
Sample Organization Contact: (559) 441-5719
Type of Sample: Informational
Type of Material: Hot Mix Asphalt
Sample Taken Date: 01/06/2022
Date that the sample was received by the laboratory/organization performing the testing: 01/06/2022
The quantity of what the sample constitutes: 12 boxes, 3 bags
A brief description of the sample: 3/4" HMA-SP R25
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Construction Company Coalinga
