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
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: 2025-04-15-17
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: 04/15/2025
Date that the sample was received by the laboratory/organization performing the testing: 04/17/2025
The quantity of what the sample constitutes: 25 BX RHMA 2 BG CMB AG 1 BG HN 1 BG CRM 4 QT PG64-16 4 QT RBR BLND 2 QT RFX 2 QT ML
A brief description of the sample: 3/4" RHMA G SP .50% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0222G-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: GRANITE CONSTRUCTION DESERT HOT SPRINGS
