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: 2025-10-16-22
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: 10/16/2025
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
Source Identification (SMARA, name of Pit or Job Site): 91-33-0014, 91-33-0039
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 RJ Noble Corona Plant
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
