Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 210409 DEA: 08432724 EFIS: 0800020178
QA Service Level: 2
DIST-CO-RTE-PM: 08-RIV-8-RIV-15-6.4/9.7
Work Description: Collector/distributor system, new on-ramps, bridges, RW, sound walls, drainage, signal and lighting, signage, freeway widening
Location Description: I-15 from Winchester Road to I-215 Junction in Temecula
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Mike Bergevin Structure Rep.: Arnel Vega
DIME Sample ID: 2025-06-17-64
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: 06/17/2025
Date that the sample was received by the laboratory/organization performing the testing: 06/19/2025
The quantity of what the sample constitutes: 32 BX RHMA 4 QT PG64-16 2 QT RBR BLND 2 QT LAS 4 BG CMB AGG 1 BG EA HN & CRM RBR
A brief description of the sample: 3/4" RHMA G SP 0.5% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0378G-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA PERRIS
