Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
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
DIME Sample ID: 2025-02-14-8
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: Crumb Rubber Modifier
Sample Taken Date: 02/14/2025
Date that the sample was received by the laboratory/organization performing the testing: 02/20/2025
The quantity of what the sample constitutes: 2 bags Crumb Rubber Hi- Nat
A brief description of the sample: Crumb Rubber Hi - Natural
From where was the sample collected: Manufacturer
Laboratory sample identification: 0134G-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: LHoist/ HF Sinclair/ CRM of Amer/ Fisher Sand and Gravel
DIME Test ID: 2025-02-14-8-1
Test Method: CTM 385-July 2022: Method of Test for Crumb Rubber Modifier (CRM)
Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: (909) 829-3029
Data has not been verified.
