Sample Record for 2025-07-22-27
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1000101 DEA: 081J2904 EFIS: 0818000015
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-215-25.0/R31.2
Work Description: RHMA, HMA, REPLACE AC SURFACING, AND COLD PLANE AC PVMT.
Location Description: RIVERSIDE COUNTY IN AND NEAR PERRIS FROM 0.1 MILE SOUTH OF SAN JACINTO RIVER BRIDGE TO 0.3 MILE NORTH OF RAMONA EXPRESSWAY
Contractor Name: COFFMAN SPECIALTIES, INC.
Contractor Address: 9685 Via Excelencia, Suite 200, San Diego, CA 92126
Resident Engineer: Mohamad Alsheikh Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2025-07-22-27
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: Aggregate
Sample Taken Date: 07/22/2025
Date that the sample was received by the laboratory/organization performing the testing: 07/24/2025
The quantity of what the sample constitutes: 4 bags comb agg, 2 bags RAP
A brief description of the sample: PSUE 3/4" HMA-A-SP R25 0.5% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0459A-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Chandler Agg, Valero, Ingevity
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-33-0098
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Belt Cut at Martin Marietta Lake Elsinore Plant
Where the material sample would have been placed if not sampled: Asphalt Paving
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: 53417195
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
