Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000661 DEA: 081J2704 EFIS: 0818000014
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-247-0.0/23.0
Work Description: RUBBERIZED HMA, HMA (TYPE A), COLD PLANE AC PVMT & REPLACE AC SURF.
Location Description: SAN BERNARDINO COUNTY IN YUCCA VALLEY FROM ROUTE 62 TO 0.4 MILE WEST OF GIN ROAD
Contractor Name: SULLY-MILLER CONTRACTING COMPANY
Contractor Address: 135 S State College Blvd, Brea, CA 92821
Resident Engineer: Walid Saoud Structure Rep.: Unknown
DIME Sample ID: 2025-05-01-46
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: Hot Mix Asphalt
Sample Taken Date: 05/01/2025
Date that the sample was received by the laboratory/organization performing the testing: 05/07/2025
The quantity of what the sample constitutes: 24 BX RHMA 4 QT PG64-16 4 QTS RBR BLND 2 QTS EVO 2 QTS RFX 4 BGS CMB AGG 1 BG EA HN & CRM
A brief description of the sample: 3/4" RHMA G SP 0.3% EVO
From where was the sample collected: Manufacturer
Laboratory sample identification: 0277G-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Blue Diamond-Victorville
