Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000682 DEA: 09379104 EFIS: 0919000005
QA Service Level: 1
DIST-CO-RTE-PM: 09-INY-395-91.6/100.8
Work Description: CONSTRUCT HMA, CURB RAMPS, AND ELECTRICAL SYSTEMS.
Location Description: INYO COUNTY AT AND NEAR BIG PINE FROM 0.1 MILE SOUTH OF ELNA ROAD TO SOUTH JUNCTION ROUTE 168
Contractor Name: ROAD AND HIGHWAY BUILDERS, LLC.
Contractor Address: P.O. Box 70846, Reno, N V, 89570
Resident Engineer: Adam Zumstein Structure Rep.: Unknown
DIME Sample ID: 2025-10-02-1
TL Number from the TL Form:
Sample Submitted By Organization: CT D09 - Bishop Field Laboratory
Sample Organization Contact: (760) 872-5211
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 10/02/2025
Date that the sample was received by the laboratory/organization performing the testing: 10/02/2025
The quantity of what the sample constitutes: 250 Tons
A brief description of the sample: CR136 A,B,C
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RHB Plant Independence
