Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000607 DEA: 081K6904 EFIS: 0819000090
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-74-5.7/11.8
Work Description: ROCK EXCAVATION, HMA (TYPE A), RHMA-G, AND CABLE NET DRAPERY SYSTEM.
Location Description: RIVERSIDE COUNTY IN AND NEAR LAKE ELSINORE FROM MONTE VISTA STREET TO GRAND AVENUE
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: Unknown
Resident Engineer: Joseph Lopez Structure Rep.: Unknown
DIME Sample ID: 2025-10-21-23
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: 10/21/2025
Date that the sample was received by the laboratory/organization performing the testing: 10/24/2025
The quantity of what the sample constitutes: 24 BX HMA 4 QT PG58-16 1 QT LAS 4 BG CMB AGG 2 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: 0664A-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Martin Marietta Lake Elsinore
