Sample Record for 2023-04-07-25
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 215336 DEA: 051G9804 EFIS: 0516000009
QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO-1-10.0/16.8
Work Description: RHMA (GAP GRADED), RETAINING WALL, CURB RAMPS AND LIGHTING SYSTEMS.
Location Description: SAN LUIS OBISPO COUNTY FROM GRACIA WAY AT OCEANO TO ROUTE 1/101 SEPARATION IN PISMO BEACH.
Contractor Name: CALPORTLAND CONSTRUCTION
Contractor Address: 1625 E DONOVAN RD, SANTA MARIA, CA 93454
Resident Engineer: ALBERT REED Structure Rep.: Sal Heredia
Sample Information
DIME Sample ID: 2023-04-07-25
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Santa Maria Field Laboratory
Sample Organization Contact:
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 04/07/2023
Date that the sample was received by the laboratory/organization performing the testing: 04/07/2023
The quantity of what the sample constitutes: Material Stockpile
A brief description of the sample: Class 2 Aggregate Subbase
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CalPortland Rocky Canyon
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-40-0013
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 at the Plant
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
