Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 99999 DEA: 0322222
QA Service Level:
DIST-CO-RTE-PM: 03-SAC,OMG-888,99,80-0.6-0.6
Work Description: THIS PROJECT RECORD WAS ADDED FOR DIME TESTERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Location Description: THIS PROJECT RECORD WAS ADDED FOR DIME TESTERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Michael Maksimovich Structure Rep.: Unknown
DIME Sample ID: 2021-11-17-38
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Materials Management Branch Field Office
Sample Organization Contact: (562) 500-5861
Type of Sample: Verification
Type of Material: Hot Mix Asphalt
Sample Taken Date: 11/17/2021
Date that the sample was received by the laboratory/organization performing the testing: 08/02/2021
The quantity of what the sample constitutes: 160 Boxes
A brief description of the sample: 3/4" HMA-A PG 64-28PM 12% RAP
From where was the sample collected: Supplier
Laboratory sample identification: 022-001
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: George Reed - Clements Plant
