Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214486 DEA: 080K1224 EFIS: 0815000244
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15-R28.6/37.5
Work Description: REHBILIATATE EXISTING MAINLINE AND RAMP PAVEMENT
Location Description: SAN BERNARDINO COUNTY IN HESPERIA AND VICTORVILLE FROM OAK HILL ROAD OVERCROSSING TO 0.1 MILE SOUTH OF BEAR VALLEY ROAD OVERCROSSING
Contractor Name: SULLY - MILLER CONTRACTING COMPANY
Contractor Address: 135 S STATE COLLEGE BLVD. 400, BREA, CA 92821
Resident Engineer: Larry J Canuti Structure Rep.: Taghreed Al-khateeb
DIME Sample ID: 2024-10-10-95
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: Asphalt Binder
Sample Taken Date: 10/10/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/14/2024
The quantity of what the sample constitutes: 1can
A brief description of the sample: Asphalt Binder Sample
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Blue Diamond-Victorville
Performance Grade: PG 58-34 M
Modified:
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: San Joaquin Refinery - Bakersfield CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
