Sample Record for 2015-01-02-2
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 7463 DEA: 042640U4 EFIS: 0412000195
QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-101-0.9/3.6
Work Description: CONSTRUCT PETALUMA BLVD SOUTH INTERCHANGE, REPLACE PETALUMA RIVER BR
Location Description: SONOMA COUNTY IN AND NEAR PETALUMA FROM GUNN DRIVE TO ROUTE 101/116 SEPARATION AND OVERHEAD
Contractor Name: GHILOTTI - CC MYERS JV
Contractor Address: 3286 Fitzgerald Road, Rancho Cordova, CA 95742
Resident Engineer: Richard Duncan Structure Rep.: Brian Beaudoin
Sample Information
DIME Sample ID: 2015-01-02-2
TL Number from the TL Form: C916989
Sample Submitted By Organization: CT HQ - Sacramento Aggregate Testing Laboratory
Sample Organization Contact: (916) 227-7204
Type of Sample: Annual Source Testing
Type of Material: Aggregate
Sample Taken Date: 01/02/2015
Date that the sample was received by the laboratory/organization performing the testing: 02/18/2015
The quantity of what the sample constitutes: 1 bag
A brief description of the sample: Sand
From where was the sample collected: Source
Laboratory sample identification: 15FPCC-0087
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Canyon Rock Quarry
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-49-0004::CANYON ROCK CO., INC.
The fabricator's/manufacturer's product name for the sample: Unknown
The fabricator/manufacturer designation for the sample: Unknown
The plant number: Unknown
A detailed description of where the material sample was collected: Stockpile
Where the material sample would have been placed if not sampled: Unknown
Primary Aggregate Nominal Size:
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
