Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215425 DEA: 06360244 EFIS: 0613000005
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-99-30.6/35.2
Work Description: Widen Freeway & Bridge Construction (Concrete Bridge)
Location Description:
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVE, SYLMAR, CA, 91342
Resident Engineer: Javier Huerta Structure Rep.: Ramandeep Guraya
DIME Sample ID: 2024-04-12-12
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: 04/12/2024
Date that the sample was received by the laboratory/organization performing the testing: 04/12/2024
The quantity of what the sample constitutes: L7SL06
A brief description of the sample: 3/4" HMA -A PG 70-10
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Martin Mariatta
Source Identification (SMARA, name of Pit or Job Site): 0613000005
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: Conveyor Belt
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: 7
Sublot number: 6
Aggregate Mix Number:
