Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000681 DEA: 081J7204 EFIS: 0818000099
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-40-S0.0/S0.8,0.0/R15.0
Work Description: REPLACE AC SURFACING, COLD PLANE AC PAVEMENT, HMA, RSP, AND MGS.
Location Description: SAN BERNARDINO COUNTY IN AND NEAR BARSTOW FROM 0.1 MILE WEST OF ROBERTA STREET TO MONTARA ROAD AND FROM ROUTE 15 TO 0.4 MILE EAST OF LAVA WASH BRIDGE
Contractor Name: SULLY-MILLER CONTRACTING COMPANY
Contractor Address: Unknown
Resident Engineer: Khoa Nguyen Structure Rep.: Unknown
DIME Sample ID: 2025-04-07-20
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: Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 04/07/2025
Date that the sample was received by the laboratory/organization performing the testing: 04/09/2025
The quantity of what the sample constitutes: 24 BX HMA 2 BG CMB LT AGG 1 BG RP 3 2 QTS PG64-16 VRGN AGGS
A brief description of the sample: 3/4" HMA A SP R25 LSM 1.0%
From where was the sample collected: Manufacturer
Laboratory sample identification: 0200A-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Blue Diamond-Victorville
