Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994191 DEA: 081G8304 EFIS: 0816000079
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-40-R100.8/R101.8
Work Description: HMA, STRUCTURAL CONC, BAR REINFORCING STEEL, CRSP & IMPORTED BORROW.
Location Description: SAN BERNARDINO COUNTY AT ESSEX FROM 1.1 MILES EAST OF ESSEX ROAD OVERCROSSING TO 0.5 MILE EAST OF HALFWAY HILLS WASH BRIDGE
Contractor Name: SKANSKA USA CIVIL WEST CALIFORNIA DISTRICT INC.
Contractor Address: 1995 Agua Mansa Rd, Riverside, CA 92509
Resident Engineer: Anthony Doan Structure Rep.: Jegbefume Adodo
DIME Sample ID: 2025-01-07-13
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Barstow Field Laboratory 1
Sample Organization Contact: (760) 252-9216
Type of Sample: Quality Assurance
Type of Material: Soil
Sample Taken Date: 01/07/2025
Date that the sample was received by the laboratory/organization performing the testing: 01/07/2025
The quantity of what the sample constitutes: 50 lb
A brief description of the sample: Structural Backfill Material
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CTM 231 TEST LOCATION
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Job site
Where the material sample would have been placed if not sampled:
