Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001001 DEA: 081N7704 EFIS: 0823000047
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-173-L0.0/L7.7
Work Description: COLD PLANE AC PVMT, HMA (TYPE A), AND REPLACE AC SURFACING.
Location Description: SAN BERNARDINO COUNTY IN HESPERIA FROM ROUTE 138 TO 0.5 MILE EAST OF ARROWHEAD LAKE ROAD
Contractor Name: CALMEX ENGINEERING, INC.
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2025-09-15-118
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: Asphalt Binder
Sample Taken Date: 09/15/2025
Date that the sample was received by the laboratory/organization performing the testing: 08/19/2025
The quantity of what the sample constitutes: 1can
A brief description of the sample: Asphalt Rubber Binder
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: VULCA-ORO GRANDE
Performance Grade: PG 58-22
Modified:
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: Valero Marketing & Supply - Wilmington CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
