Project Information

Project ID: 993333 DEA: 04264724 EFIS: 0419000068 QA Service Level: 1

DIST-CO-RTE-PM: 04-MRN-101-R20.8/27.1

Work Description: CIP BRIDGES, CONSTRUCT ROADWAY, RETAINING WALLS AND MODIFY ELECTRICAL.

Location Description: MARIN COUNTY IN AND NEAR NOVATO FROM 0.1 MILE SOUTH OF FRANKLIN AVENUE OVERHEAD TO 0.5 MILE SOUTH OF SAN ANTONIO CREEK BRIDGE

Contractor Name: GHILOTTI CONSTRUCTION CO. INC. (RILEY GENAZZI & JOSH SERAFINO)

Contractor Address: 246 GHILOTTI AVE., SANTA ROSA, CA 95407

Resident Engineer: Fabio La Serna Structure Rep.: Jeremy Light

Sample Information

DIME Sample ID: 2023-02-13-64

TL Number from the TL Form:

Sample Submitted By Organization: CT D04 - Petaluma Field Laboratory

Sample Organization Contact: (510) 385-6841

Type of Sample: Verification

Type of Material: Aggregate

Sample Taken Date: 02/13/2023

Date that the sample was received by the laboratory/organization performing the testing: 02/14/2023

The quantity of what the sample constitutes: 1 bag

A brief description of the sample: half inch HMA Type A

From where was the sample collected: Fabricator

Laboratory sample identification:

Structure unique identifier:

Structure name:

The fabricator/manufacturer/facility name: Dutra Richmond

Material Information

Source Identification (SMARA, name of Pit or Job Site): 91-49-0008

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: Combined Hot Bins

Where the material sample would have been placed if not sampled:

Primary Aggregate Nominal Size: 1/2 inch

The concrete mix design number:

Lot number:

Sublot number:

Aggregate Mix Number:

Tests Assigned to this Sample

DIME Test ID	Test Method	Assigned Date	Test Date	Assigned By	Assigned Lab	Assigned To
2023-02-13-64-1	AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)	03/21/2023	02/14/2023	Glenn Cea	CT D04 - Petaluma Field Laboratory	Anthony Valdez
2023-02-13-64-2	AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)	03/21/2023	Not scheduled	Glenn Cea	CT D04 - Petaluma Field Laboratory	Anthony Valdez
2023-02-13-64-4	AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)	03/21/2023	02/14/2023	Glenn Cea	CT D04 - Petaluma Field Laboratory	Anthony Valdez

Sample Record for 2023-02-13-64

Project Information