Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000943 DEA: 09404304 EFIS: 0924000070
QA Service Level: 1
DIST-CO-RTE-PM: 09-MNO-120-32.1/R35.0,48.0/50.0
Work Description: COLD IN-PLACE RECYCLE EXISTING PAVEMENT AND PLACE HMA.
Location Description: MONO COUNTY NEAR BENTON FROM 0.5 MILE EAST TO 3.4 MILES EAST OF BAXTER\\\\'S ROAD AND FROM 2.0 MILES WEST OF BLACK LAKE ROAD TO BLACK LAKE ROAD
Contractor Name: PAPICH CONSTRUCTION COMPANY, INC.
Contractor Address: 398 Sunrise Terrace, Arroyo Grande, CA 93420
Resident Engineer: Malissa Reynolds Structure Rep.: Unknown
DIME Sample ID: 2025-08-06-88
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: Dispute Resolution
Type of Material: Hot Mix Asphalt
Sample Taken Date: 08/06/2025
Date that the sample was received by the laboratory/organization performing the testing: 09/22/2025
The quantity of what the sample constitutes: 8 BOXES OF HMA, 2 QTS PG58-34M, 1 SMALL BAG OF CMB AGG, 1 BAG RAP
A brief description of the sample: 1/2" HMA A SP RAP 25%
From where was the sample collected: Manufacturer
Laboratory sample identification: 0596A-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Lee Vining
