Sample Record for 2025-10-15-22
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
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
Sample Information
DIME Sample ID: 2025-10-15-22
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: 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: 2 bags comb agg, 1 bag RAP
A brief description of the sample: PSUE 3/4" HMA-A-SP R25 LAS 0.5%
From where was the sample collected: Manufacturer
Laboratory sample identification: 0649A-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Chandler Agg/ Valero/ Ingevity
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-33-0098
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 Martin Marietta Lake Elsinore Plant
Where the material sample would have been placed if not sampled: Asphalt Paving
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: 53417195
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
