Sample Record for 2024-12-09-34
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 994586 DEA: 081C08U4 EFIS: 0822000142
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-10-R134.0/R156.5
Work Description: PLACE HMA (TYPE A), JPCP, IMPORTED BORROW, ROADWAY EXCAVATION & CL2 AB
Location Description: RIVERSIDE COUNTY FROM 1.1 MILES WEST OF WILEY WELL ROAD OVERCROSSING TO CALIFORNIA/ARIZONA STATE LINE
Contractor Name: FISHER SAND & GRAVEL CO.
Contractor Address: 19062 San Jose Avenue, LA Puente, CA 91748
Resident Engineer: Ryan Espoy (cc on Reports) Structure Rep.: Tim Flores
Sample Information
DIME Sample ID: 2024-12-09-34
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: Aggregate
Sample Taken Date: 12/09/2024
Date that the sample was received by the laboratory/organization performing the testing: 12/16/2024
The quantity of what the sample constitutes: 2 BAGS EA OF VIRGIN AGG(3/4,3/8 WASHED MA SAND), 2 BAG RAP
A brief description of the sample: 3/4" HMA-A-SP-R24 1.0% LSM
From where was the sample collected: Manufacturer
Laboratory sample identification: 0682A-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Fisher Sand and Gravel-Tempe
Material Information
Source Identification (SMARA, name of Pit or Job Site): EHRENBERG PIT CM203
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: EHRENBERG PIT/HOLLY FRONTIER/LHOIST/ PROJECT ROADWAY
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: CA125MA
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
