Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000216 DEA: 081G6304 EFIS: 0816000043
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-111-47.2/55.3
Work Description: RHMA-G, REPLACE AC SURFACING, AND COLD PLANE AC PVMT.
Location Description: RIVERSIDE COUNTY IN PALM SPRINGS FROM GOLF CLUB DRIVE TO WEST GATEWAY DRIVE
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 3800 Monroe St, Indio Ca 92203
Resident Engineer: Francisco Montellano Structure Rep.: Unknown
DIME Sample ID: 2024-10-30-51
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: 10/30/2024
Date that the sample was received by the laboratory/organization performing the testing: 11/21/2024
The quantity of what the sample constitutes: 1 BAG OF CRUMB RUBBER
A brief description of the sample: SCRAP
From where was the sample collected: Manufacturer
Laboratory sample identification: 0640G-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Construction Company
