Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001156 DEA: 081L9104 EFIS: 0821000038 COOP: 081734
QA Service Level: 2
DIST-CO-RTE-PM: 08-SBD-38-51.9
Work Description: State Highway 38 at Stanfield Cutoff Roundabout
Location Description: Intersection of Stanfield Cutoff and State Highway 38 in the Big Bear area
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Kelsie Cranford Structure Rep.: Unknown
DIME Sample ID: 2025-07-16-35
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: 07/16/2025
Date that the sample was received by the laboratory/organization performing the testing: 07/17/2025
The quantity of what the sample constitutes: 24 BX HMA 4 QT PG58-22 1 QT EVO 4 BGS CMB AGG 2 BGS RAP
A brief description of the sample: 3/4" HMA A RAP20% EVO 0.5%
From where was the sample collected: Manufacturer
Laboratory sample identification: 0447A-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Matich-Lytle Creek
