Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214892 DEA: 06442554 EFIS: 0612000176 COOP: 061699
QA Service Level: 1
DIST-CO-RTE-PM: 06-KER-46-29.7/31.9
Work Description: CONVERT 2-LANE TO 4-LANE HMA PAVEMENT AND CONSTRUCT NEW BRIDGE.
Location Description: KERN COUNTY AT AND NEAR LOST HILLS FROM 0.2 MILE WEST OF CALIFORNIA AQUEDUCT BRIDGE TO 1.4 MILES EAST OF LOST HILLS ROAD
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 3005 James Road, Bakersfield, CA 93308
Resident Engineer: Trever Shiplee Structure Rep.: Gabriel Macias
DIME Sample ID: 2023-08-18-40
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Bakersfield Field Laboratory
Sample Organization Contact: 661-549-8281
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 08/18/2023
Date that the sample was received by the laboratory/organization performing the testing: 08/18/2023
The quantity of what the sample constitutes: 4bags of coldfeed agg,1 bags of virgin aggregate ,
A brief description of the sample: 3/4 RHMA
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Solari
Source Identification (SMARA, name of Pit or Job Site): 91-15-0114
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: HMA Plant Cold Feed
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: 3
Sublot number: 10
Aggregate Mix Number:
