Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 66667 DEA: JMFPP EFIS: 0019000043
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for submitting Sample information for JMF Prequalification Program.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2022-01-19-35
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3675 - Fresno 2
Sample Organization Contact: (559) 304-3318
Type of Sample: Informational
Type of Material: Hot Mix Asphalt
Sample Taken Date: 01/19/2022
Date that the sample was received by the laboratory/organization performing the testing: 03/07/2022
The quantity of what the sample constitutes: 24 boxes
A brief description of the sample: 1/2" HMA Type A
From where was the sample collected: Source
Laboratory sample identification: 022-006
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Bradshaw
