Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994328 DEA: 081H0604 EFIS: 0816000130
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-74-34.3/45.1
Work Description: FIBER OPTIC CABLE SYSTEMS, RHMA, HMA, AND MINOR CONCRETE.
Location Description: RIVERSIDE COUNTY IN AND NEAR HEMET FROM WINCHESTER ROAD TO FAIRVIEW AVENUE
Contractor Name: GRIFFITH COMPANY
Contractor Address: Unknown
Resident Engineer: Omar Sanchez Structure Rep.: Arnel Vega
DIME Sample ID: 2024-12-04-9
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: 12/04/2024
Date that the sample was received by the laboratory/organization performing the testing: 12/05/2024
The quantity of what the sample constitutes: 12 BX OF RHMA 1 QT PG64-16, 1 QT RBR BLND 1 QT LAS 6 BGS CMB AGG
A brief description of the sample: 1/2" RHMA G SP 1.0% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0661G-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA-Perris
