HEADER SECTION
Date/Time	Date and time, in military format,  when the sample was taken (5/1/97   1330).
Weather	Brief description of weather (sunny & hot, light rain, windy & cool, etc.).
Project	Description of project including town, roadway and type of work (West Springfield/I91 Resurfacing).
Contract #	State contract Number.
Contractor	Contractor who is performing work.
Pay Item #	Contract Item number for which the material is being tested.
Source	Name and location of source of  material.
Plant Type	Type of plant being used to produce material (batch plant, drum plant, etc).
Lab/Location	Name and location of testing laboratory performing material testing.
Date Rec’d.	Lab number to be assigned by the testing laboratory and the date which the lab received the sample.
Lab Login #	Number assigned to sample by testing laboratory.
Material ID	Description of material type, which is being sampled, examples include, but are not limited to the following: 12.5mm HMA Surface, coarse ag., fine ag.
Material #	Specification number, which corresponds to the material, listed under the Material ID or Producer’s Mix Number.
Sample #	Unique number to be assigned in order to clearly identify the sample being tested.
Sample Type	Indicate why the sample was taken: QA – quality acceptance, QC – quality control, IA – independent assurance, AV – acceptance verification, PC – process control, Other.  Select one of the 6 choices.
Sampled By/Cert. #	Name and Certification No. of the person who obtained the sample.
Random Sample:	Is the sample random?  (select one)
Lot #	A unique sequential number, starting with 1, assigned to represent a specific quantity spelled out in the specifications for each Pay Item No.
Sublot #	A unique sequential number, starting with 1, assigned to represent a specific quantity spelled out in the specifications within each specific lot.  Sublot numbers should not be repeated within a lot.  Sublot numbers start with 1 and progress as needed, they do not start over with each day’s production.  If sublot numbers 1 to 4 were used on the first day of production the sublot numbers would start with 5 on the second day of production.
Sample Location	Location from which the sample was taken.  Depending on the type of sample the following would be appropriate locations: hopper, stockpile, conveyor belt, truck, behind paver, center lane I91SB , bridge deck, footing.  This is not meant to be a complete list of locations, location should be descriptive enough so that it clearly defines where the sample came from.
Station	Standard roadway baseline stationing which is established on the project site (Sta.134+50)
Offset	Offset, right or left from the base line of the project stationing (4m left).
FOOTER SECTION
Comments	Comments on anything relative to taking or testing of the sample.
Tested By	Name of the person who performed test or tests on the sample.
Certification #	Certification No. of person who performed test or tests on the sample.
Date	Date which the test or tests were performed
Reviewed By	Name of the person who has reviewed the test results and is responsible for acceptance of results
Certification #	Certification No. of person who has reviewed the test results and is responsible for acceptance of results.
Date	Date which the test results were reviewed
Results within Specification Limits	Check boxes to provide clear summary of outcome of test results, simply check the box that applies.
Results outside Specification Limits
FONTS AND COLOR SCHEMES
Yellow Shading & Black text	Text in black followed by cells shaded yellow indicates that user data entry is required.  All user input is in cells shaded yellow.
Blue text	Blue text indicates intermediate calculations performed by the spreadsheet.
Red-Bold text, within a bold box	Red-Bold text, within a bold box indicates final results that are calculated by the spreadsheet.