Sample Record for 2014-07-30-5304343
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 7690 DEA: 080M94U4 EFIS: 0812000211
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV,SBD-91,215-21.5/21.7,43.2/45.2,0.0/5.1
Work Description: CONST RETAINING WALLS, BRIDGES AND WIDEN ROADWAY WITH HMA
Location Description: RIVERSIDE AND SAN BERNARDINO COUNTIES ON ROUTE 91 FROM SPRUCE STREET TO 60/91/215 SEPARATION AND ON ROUTE 215 FROM 60/91/215 SEPARATION TO ORANGE SHOW ROAD
Contractor Name: Ames Construction Inc
Contractor Address: 391 N Main St. Ste 111, Corona, CA 92880
Resident Engineer: Manny Yogarajah Structure Rep.: Andy D Quach
Sample Information
DIME Sample ID: 2014-07-30-5304343
TL Number from the TL Form: Unknown
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 07/30/2014
Date that the sample was received by the laboratory/organization performing the testing: 07/30/2014
The quantity of what the sample constitutes: 1 Bag
A brief description of the sample: Class 2 Aggregate Base
From where was the sample collected: Job Site
Laboratory sample identification: 4206B
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: None
Material Information
Source Identification (SMARA, name of Pit or Job Site): Unknown
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: I 215 Median Sta 18 00
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
