Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000216 DEA: 081G6304 EFIS: 0816000043 COOP: NONE
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-111-47.2/55.3
Work Description: RHMA-G, REPLACE AC SURFACING, AND COLD PLANE AC PVMT.
Location Description: RIVERSIDE COUNTY IN PALM SPRINGS FROM GOLF CLUB DRIVE TO WEST GATEWAY DRIVE
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 3800 Monroe St, Indio Ca 92203
Resident Engineer: Francisco Montellano Structure Rep.: Unknown
DIME Sample ID: 2025-02-24-41
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: 02/24/2025
Date that the sample was received by the laboratory/organization performing the testing: 02/26/2025
The quantity of what the sample constitutes: 1 Bag Of Crumb Rubber Hi-Nat
A brief description of the sample: Crumb Rubber Hi-Natural
From where was the sample collected: Manufacturer
Laboratory sample identification: 0142G-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Ingevity, CRM, SJR, Granite, Vlo, West Coast Aggs
DIME Test ID: 2025-02-24-41-1
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.
