Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993603 DEA: 051N7004 EFIS: 0521000081
QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO-166-16.0/21.0
Work Description: PARTIAL DEPTH RECYCLING AND OVERLAY WITH RHMA (GAP GRADED).
Location Description: SAN LUIS OBISPO COUNTY ABOUT 8 MILES EAST OF SANTA MARIA FROM 0.5 MILE WEST OF HUASNA RIVER BRIDGE TO 1.9 MILES WEST OF CUYAMA RIVER BRIDGE.
Contractor Name: PAPICH CONSTRUCTION COMPANY INC.
Contractor Address: Unknown
Resident Engineer: Thomas Petersen Structure Rep.: Unknown
DIME Sample ID: 2022-11-15-1
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Santa Maria Field Laboratory
Sample Organization Contact:
Type of Sample: Quality Control
Type of Material: Aggregate
Sample Taken Date: 11/15/2022
Date that the sample was received by the laboratory/organization performing the testing: 11/15/2022
The quantity of what the sample constitutes: L1SL1
A brief description of the sample: 1/2" RHMA-G
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Calportland/rocky cyn
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: Belt Discharge
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
