Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995493 DEA: 081G6704 EFIS: 0816000049
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-79-5.4/11.4
Work Description: HOT MIX ASPHALT, SOIL NAIL, STRUCTURAL CONCRETE AND ROADWAY EXC.
Location Description: RIVERSIDE COUNTY NEAR TEMECULA FROM 0.4 MILE SOUTH OF SAGE ROAD TO 1.1 MILES SOUTH OF PAUBA ROAD
Contractor Name: ORTIZ ENTERPRISES, INC.
Contractor Address: 6 CUSHING STE 200, IRVINE, CA 92618
Resident Engineer: Osama Abdalla Structure Rep.: Arnel Vega
DIME Sample ID: 2025-10-15-20
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: Production Start-Up
Type of Material: Hot Mix Asphalt
Sample Taken Date: 10/15/2025
Date that the sample was received by the laboratory/organization performing the testing: 10/17/2025
The quantity of what the sample constitutes: 24 BX HMA 3 QT PG64-16 2BG CMB AGG 1 BG RAP
A brief description of the sample: 3/4" HMA A SP R25 LAS .5%
From where was the sample collected: Manufacturer
Laboratory sample identification: 0649A-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Martin Marietta Lake Elsinore
