Sample Record for 2023-02-10-47
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 215486 DEA: 040A0204 EFIS: 0400000129
QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-1-15-15.7
Work Description: Construct roadway and bridge with structural concrete and CIDH piling
Location Description: District-County-Route-Post Mile: 04-Son-1-R15.0/R15.7
Contractor Name: BRIDGEWAY CIVIL CONSTRUCTORS, INC.
Contractor Address: 4950 Allison Parkway, # A, Vacaville, CA 95688
Resident Engineer: Fabio La Serna Structure Rep.: Bunma Nou
Sample Information
DIME Sample ID: 2023-02-10-47
TL Number from the TL Form: 861615
Sample Submitted By Organization: CT D04 - Petaluma Field Laboratory
Sample Organization Contact: (510) 385-6841
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 02/10/2023
Date that the sample was received by the laboratory/organization performing the testing: 02/10/2023
The quantity of what the sample constitutes: 4 Bags
A brief description of the sample: HMA Aggregates
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: BoDean Santa Rosa
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-49-0032
The fabricator's/manufacturer's product name for the sample: 700-SPW-16
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Pulled from Bin 2
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/8 inch
The concrete mix design number:
Lot number: 1
Sublot number: 1
Aggregate Mix Number:
Test Results
