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Sample Record for 2023-03-03-40

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 215753 DEA: 050N72U4 EFIS: 0520000169 QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-4.4/R7.7
Work Description: Please cc Office Engineer Ni Nyoman Paul on reports sent to RE and SR. Construct High Occupancy Vehicle (HOV) lanes on U.S. Route 101 and rehabilitation - Segment 4B.
Location Description: 101 freeway in Summerland, CA
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 5335 Debbie Road, Santa Barbara, CA 93111
Resident Engineer: Tristan Gebhart Structure Rep.: Emiliano Berntsen

Sample Information

DIME Sample ID: 2023-03-03-40
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Carpinteria Field Laboratory
Sample Organization Contact: (805) 621-3616
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 03/03/2023
Date that the sample was received by the laboratory/organization performing the testing: 03/06/2023
The quantity of what the sample constitutes: 18 CY
A brief description of the sample: PCC Aggregates
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Martin Marietta Goleta

Material Information

Source Identification (SMARA, name of Pit or Job Site): 91-42-0003
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: Stockpile @ Plant
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: 63511N0P
Lot number:
Sublot number:
Aggregate Mix Number:

Test Results