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: 2024-10-11-79
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: Verification
Type of Material: Asphalt Rubber Binder
Sample Taken Date: 10/11/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/24/2024
The quantity of what the sample constitutes: 1can
A brief description of the sample: Asphalt Rubber Binder
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite-Desert Hot Springs
Asphalt modifier supplier:
Performance Grade: PG 64-16
Lot number:
Sublot number:
Asphalt Rubber Binder Mix Number:
