Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994588 DEA: 081H3904 EFIS: 0817000032
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15-R20.5/R21.6,R25.5/R30.7
Work Description: CONSTRUCT BUILDING, ROADWAY EXC, JPCP, AND TEMPORARY BARRIER SYSTEM.
Location Description: SAN BERNARDINO COUNTY FROM 0.6 MILE NORTH OF CLEGHORN ROAD UNDERCROSSING TO 0.5 MILE SOUTH OF ROUTE 138 AND FROM 0.5 MILE SOUTH OF TRUCK SAFETY CHECK AREA TO 0.4 MILE NORTH OF OAK HILL ROAD OVERCROSSING
Contractor Name: POWELL CONSTRUCTORS INC
Contractor Address: 8555 BANANA AVE, FONTANA, CA 92335
Resident Engineer: Mauricio Santa Cruz Structure Rep.: Oluwatayo (Tayo) Ogeyemi
DIME Sample ID: 2025-04-05-6
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: Production Start-Up
Type of Material: Hot Mix Asphalt
Sample Taken Date: 04/05/2025
Date that the sample was received by the laboratory/organization performing the testing: 04/09/2025
The quantity of what the sample constitutes: 18 BX HMA 2 QTS PG64-28M 2 BGS CMB AGG 1 BG RAP
A brief description of the sample: 3/4" HMA A SP R15
From where was the sample collected: Manufacturer
Laboratory sample identification: 0198A-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA Corona
