Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000082 DEA: 081J8704 EFIS: 0818000124
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-15-16.3/52.3
Work Description: MINOR CONCRETE, HMA (TYPE A), MODIFYING SIGNAL AND LIGHTING SYSTEMS.
Location Description: RIVERSIDE COUNTY AT VARIOUS LOCATIONS FROM BUNDY CANYON ROAD UNDERCROSSING IN WILDOMAR TO PHILADELPHIA STREET UNDERCROSSING IN EASTVALE
Contractor Name: BEADOR CONSTRUCTION COMPANY, INC.
Contractor Address: Unknown
Resident Engineer: Xavier Avila Structure Rep.: Unknown
DIME Sample ID: 2025-10-16-21
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: Hot Mix Asphalt
Sample Taken Date: 10/16/2025
Date that the sample was received by the laboratory/organization performing the testing: 10/20/2025
The quantity of what the sample constitutes: 24 Boxes of HMA, 4 Bags of CMB Aggs, 2 Bags of RAP
A brief description of the sample: 3/4" HMA-A-SP R25 EVO 0.25%
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RJ Noble-Corona
