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: 2025-12-17-17
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: 12/17/2025
Date that the sample was received by the laboratory/organization performing the testing: 12/19/2025
The quantity of what the sample constitutes: 6 bags comb agg, 3 bags RAP
A brief description of the sample: PSUE 3/4" HMA-A-SP R25% LAS 0.5%
From where was the sample collected: Manufacturer
Laboratory sample identification: 0700A-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Valero, Ingevity, Chandler Agg Lake Elsinore
Source Identification (SMARA, name of Pit or Job Site): 91-33-0098
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 martin Marietta
Where the material sample would have been placed if not sampled: Asphalt Paving
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: 53417105
Lot number:
Sublot number:
Aggregate Mix Number:
