Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001213 DEA: 11431644 EFIS: 1122000232
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-78-N17.7
Work Description: Cold plane, RHMA overlay, Concrete Barriers, Landscape and Electrical.
Location Description: IN SAN DIEGO COUNTY FROM ROUTE 78/5 SEPARATION TO 0.3 MILE EAST OF ESCONDIDO BOULEVARD UNDERCROSSING.
Contractor Name: Skanska USA Civil West
Contractor Address: 1995 Agua Mansa Rd., Riverside, CA 92509
Resident Engineer: Yong Pak Structure Rep.: Carlos Lopez
DIME Sample ID: 2025-07-09-84
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: Crumb Rubber Modifier
Sample Taken Date: 07/09/2025
Date that the sample was received by the laboratory/organization performing the testing: 07/28/2025
The quantity of what the sample constitutes: 2 bags of Crumb Rubber Scrap
A brief description of the sample: Scrap
From where was the sample collected: Manufacturer
Laboratory sample identification: 0425O-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Martin Marietta-Lakeside
