Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000369 DEA: 09378804 EFIS: 0919000002
QA Service Level: 1
DIST-CO-RTE-PM: 09-MNO-395-R9.8/R12.6
Work Description: PLACE HMA AND ASPHALT BASE, RECYCLE PAVEMENT AND MODIFY ELECTRICAL.
Location Description: MONO COUNTY NEAR TOM\\\\'S PLACE FROM 0.5 MILE NORTH OF LOWER ROCK CREEK ROAD TO 1.3 MILES SOUTH OF SOUTH LANDING OVERCROSSING
Contractor Name: HAT CREEK CONSTRUCTION & MATERIALS, INC.
Contractor Address: Unknown
Resident Engineer: David Carruba Structure Rep.: Unknown
DIME Sample ID: 2025-07-17-44
TL Number from the TL Form:
Sample Submitted By Organization: CT D09 - Bishop Field Laboratory
Sample Organization Contact: (760) 872-5211
Type of Sample: Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 07/17/2025
Date that the sample was received by the laboratory/organization performing the testing: 07/18/2025
The quantity of what the sample constitutes: 3 Cores (41A, 41B, 41C)
A brief description of the sample: 3/4" HMA 58-34M R15
From where was the sample collected: Job Site
Laboratory sample identification: HMA Cores 41
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Five Bridges
