Sample Record for 2025-09-16-37
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1000665 DEA: 081K4004 EFIS: 0819000031
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-15-3.5/6.8
Work Description: HMA (TYPE A), RDWY EXC, STR CONC RET WALL, RUBBERIZED HMA (OGFC).
Location Description: TEMECULA FROM 0.1 MI NORTH OF TEMECULA PARKWAY TO 0.2 MI NORTH OF WINCHESTER ROAD
Contractor Name: BEADOR CONSTRUCTION COMPANY, INC.
Contractor Address: 2900 Bristol Street, Suite D204, Costa Mesa, CA 92626
Resident Engineer: Denise Sostrom Structure Rep.: Gizachew Abayneh
Sample Information
DIME Sample ID: 2025-09-16-37
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: 09/16/2025
Date that the sample was received by the laboratory/organization performing the testing: 09/17/2025
The quantity of what the sample constitutes: 6BAGS Virgin bin agg,1bag ea HI-NAT&CRM RUBBER
A brief description of the sample: JMF 1/2'' RHMA-O SP NO LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0590O-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: World oil, SJR, CRM, M.M. (91-33-0014)
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-33-0014
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 RJ Noble Corona Plant
Where the material sample would have been placed if not sampled: Asphalt Paving
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number: 51R003ARSPC
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
