Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212470 DEA: 044A1304 EFIS: 0400001106 COOP: 042718
QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-101-18.5/18.5
Work Description: CONSISTS OF MODIFICATION AND RECONSTRUCTION OF THE EXISTING US 101/HEARN AVENUE INTERCHANGE IN SONOMA COUNTY, INCLUDING REPLACING THE EXISTING TWO-LANE HEARN AVENUE OVERCROSSING WITH A NEW OVERCROSSING, AND MODIFYING THE SOUTHBOUND OFF-RAMP IN CITY
Location Description: IN SONOMA COUNTY.
Contractor Name: Ghilotti Construction Company, Inc. (Chase McPhaul)
Contractor Address: 246 Ghilotti Avenue, Santa Rosa, CA 95407
Resident Engineer: Seyed "Syd" Valeh Structure Rep.: Anthony "Tony" Tierra; Sardar Chalabe
DIME Sample ID: 2025-10-22-70
TL Number from the TL Form: C10-22-2025-01to06
Sample Submitted By Organization: CT D04 - Hayward DME / District Laboratory
Sample Organization Contact: (510) 507-3456
Type of Sample: Production Start-Up
Type of Material: Hot Mix Asphalt
Sample Taken Date: 10/22/2025
Date that the sample was received by the laboratory/organization performing the testing: 11/25/2025
The quantity of what the sample constitutes: 16 Boxes HMA
A brief description of the sample: 3/4" HMA-A +15%RAP
From where was the sample collected: Manufacturer
Laboratory sample identification: D04-SE-25-082
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: BoDean - Santa Rosa
