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: 2024-12-04-17
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: Aggregate
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: 6 Bags of Comb agg.
A brief description of the sample: PSUE 1/2" RHMA-G-SP 1% 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/ SJR/ Morelife 500/ Corona
Source Identification (SMARA, name of Pit or Job Site): 91-33-0005
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: All American Asphalt - Perris
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number: 106836
Lot number:
Sublot number:
Aggregate Mix Number:
