Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 209109 DEA: 043G9004 EFIS: 0412000557 COOP: 042513
QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-116,121-46.0/46.7,5.8/R7.4
Work Description: MODIFY EXISTING STATE ROUTE 116,121 BONNEAU ROAD INTERSECTION FROM A 4 WAY STOP CONTROLLED INTERSECTION TO A ROUNDABOUT AND SIGNALIZED INTERSECTION.
Location Description: SONOMA COUNTY
Contractor Name: O.C. JONES & SONS, INC.
Contractor Address: 1520 Fourth Street, Berkeley, CA 94710
Resident Engineer: Fabio La Serna Structure Rep.: Unknown
DIME Sample ID: 2025-09-25-76
TL Number from the TL Form: C100602
Sample Submitted By Organization: CT D04 - Hayward DME / District Laboratory
Sample Organization Contact: (510) 507-3456
Type of Sample: Production Start-Up
Type of Material: Hot Mix Asphalt
Sample Taken Date: 09/25/2025
Date that the sample was received by the laboratory/organization performing the testing: 10/03/2025
The quantity of what the sample constitutes: 16 Boxes RHMA-G
A brief description of the sample: 3/4" RHMA-G
From where was the sample collected: Manufacturer
Laboratory sample identification: D04-SE-25-067
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Materials LH (DP)
