Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000199 DEA: 050N7054 EFIS: 0518000111
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-101-10.4/11.1
Work Description: South Coast 101 HOV Lanes Project 4E South- Santa Barbara
Location Description:
Contractor Name: Granite Construction Company
Contractor Address: PO Box 6744, Santa Barbara, CA 93160
Resident Engineer: Tristan Gebhart Structure Rep.: Gary Cavafian
DIME Sample ID: 2025-04-30-66
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: Dispute Resolution
Type of Material: Hot Mix Asphalt
Sample Taken Date: 04/30/2025
Date that the sample was received by the laboratory/organization performing the testing: 05/22/2025
The quantity of what the sample constitutes: 6 BOXES OF HMA
A brief description of the sample: 1/2" HMA A SP RAP 25%
From where was the sample collected: Manufacturer
Laboratory sample identification: 0305A-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: GRANITE VENTURA
