Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 211198 DEA: 072W9304 EFIS: 0715000020
QA Service Level: 1
DIST-CO-RTE-PM: 07-VEN-33-40.0/42.0
Work Description: CONSTRUCT PAVEMENT USING COLD IN-PLACE RECYCLING AND OVERLAY WITH HMA.
Location Description:
Contractor Name: GRIFFITH COMPANY
Contractor Address: Unknown
Resident Engineer: Alan Davis Structure Rep.: Unknown
DIME Sample ID: 2016-08-05-9
TL Number from the TL Form: 836057
Sample Submitted By Organization: CT - Unassigned/General Field Laboratory
Sample Organization Contact: 5625005861
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 08/05/2016
Date that the sample was received by the laboratory/organization performing the testing: 08/11/2016
The quantity of what the sample constitutes: 3 bags
A brief description of the sample: aggregate
From where was the sample collected: Source
Laboratory sample identification: 6328b-16
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Griffith Edmonston
Source Identification (SMARA, name of Pit or Job Site): Griffith Edmonston
The fabricator's/manufacturer's product name for the sample: Unknown
The fabricator/manufacturer designation for the sample: Unknown
The plant number: Unknown
A detailed description of where the material sample was collected: source
Where the material sample would have been placed if not sampled: Unknown
Primary Aggregate Nominal Size: 1 inch
The concrete mix design number: na
Lot number:
Sublot number:
Aggregate Mix Number:
