Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001222 DEA: 042Y5204 EFIS: 0423000124
QA Service Level: 1
DIST-CO-RTE-PM: 04-SM-84-R27.7/R29.2
Work Description: COLD PLANE AC PAVEMENT AND OVERLAY WITH RHMA.
Location Description: SAN MATEO COUNTY IN MENLO PARK ON ROUTE 84 FROM ROUTE 114 TO DUMBARTON BRIDGE AND ON WILLOW ROAD AT ROUTE 114/101 SEPARATION
Contractor Name: O.C. JONES & SONS, INC.
Contractor Address: Unknown
Resident Engineer: Ethan Malonzo Structure Rep.: Unknown
DIME Sample ID: 2025-10-30-83
TL Number from the TL Form: SJ-103025-1
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: 10/30/2025
Date that the sample was received by the laboratory/organization performing the testing: 11/14/2025
The quantity of what the sample constitutes: 22 Boxes RHMA
A brief description of the sample: 1/2" RHMA-G
From where was the sample collected: Manufacturer
Laboratory sample identification: D04-SE-25-085
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Martin Marietta-Sunol Plant
