Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000231 DEA: 081N6504 EFIS: 0823000029
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-62-38.5/48.5
Work Description: RHMA-G, PARTIAL DEPTH RECYCLING, AND SHOULDER BACKING.
Location Description: SAN BERNARDINO COUNTY NEAR TWENTYNINE PALMS FROM GOPHER GROVE LANE TO GOLD CROWN ROAD
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: Unknown
Resident Engineer: Francisco Montellano Structure Rep.: Unknown
DIME Sample ID: 2024-10-04-62
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Production Start-Up
Type of Material: Hot Mix Asphalt
Sample Taken Date: 10/04/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/10/2024
The quantity of what the sample constitutes: 16 BX RHMA 4 BGS CMB AGG 2 QT PG64-16 2 QT RBR BLND 1 QT ML 1 QT RFX 1 BG CRM 1 BG HN
A brief description of the sample: 1/2" RHMA G .5% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0532G-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Desert Hot Springs
