Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000606 DEA: 081J3004 EFIS: 0818000016
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-18-90.9/R96.6
Work Description: HMA (TYPE A), MOD SIGNAL & LTG SYSTEMS, & COLD PLANE AC PVMT.
Location Description: SAN BERNARDINO COUNTY IN AND NEAR VICTORVILLE FROM APPLE VALLEY INN ROAD TO ROUTE 15/18 SEPARATION
Contractor Name: SULLY-MILLER CONTRACTING COMPANY
Contractor Address: 135 S STATE COLLEGE BLVD #400, BREA CA 92821
Resident Engineer: Alfonso Gonzalez Structure Rep.: Unknown
DIME Sample ID: 2025-02-03-8
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: Hot Mix Asphalt
Sample Taken Date: 02/03/2025
Date that the sample was received by the laboratory/organization performing the testing: 02/05/2025
The quantity of what the sample constitutes: 24 BX HMA 4 QTS PG64-16 2 QTS EVO 4 BGS CMB AGG 2 BGS RAP
A brief description of the sample: 3/4" HMA A R25 0.6% EVO
From where was the sample collected: Manufacturer
Laboratory sample identification: 0125A-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Blue Diamond Victorville
