Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000368 DEA: 081J4704 EFIS: 0818000055
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-10-R87.9,R91.0
Work Description: PARTIALLY GROUTED RSP, STRUCTURE EXCAVATION AND ROADWAY EXCAVATION.
Location Description: RIVERSIDE COUNTY NEAR CHIRIACO SUMMIT AT THREE STAR DITCH BRIDGE AND AT DETERMINATION DITCH BRIDGE
Contractor Name: GRIFFITH COMPANY
Contractor Address: 3050 BIRCH STREET, BREA, CA 92821
Resident Engineer: Peter Koury Structure Rep.: Unknown
DIME Sample ID: 2024-11-05-26
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: Crumb Rubber Modifier
Sample Taken Date: 11/05/2024
Date that the sample was received by the laboratory/organization performing the testing: 11/08/2024
The quantity of what the sample constitutes: 1 Bag of Hi-Natural
A brief description of the sample: Hi-nat
From where was the sample collected: Manufacturer
Laboratory sample identification: 0608G-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Construction Company
