Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000661 DEA: 081J2704 EFIS: 0818000014
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-247-0.0/23.0
Work Description: RUBBERIZED HMA, HMA (TYPE A), COLD PLANE AC PVMT & REPLACE AC SURF.
Location Description: SAN BERNARDINO COUNTY IN YUCCA VALLEY FROM ROUTE 62 TO 0.4 MILE WEST OF GIN ROAD
Contractor Name: SULLY-MILLER CONTRACTING COMPANY
Contractor Address: 135 S State College Blvd, Brea, CA 92821
Resident Engineer: Walid Saoud Structure Rep.: Unknown
DIME Sample ID: 2025-08-03-28
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: 08/03/2025
Date that the sample was received by the laboratory/organization performing the testing: 08/06/2025
The quantity of what the sample constitutes: 1can
A brief description of the sample: Asphalt Binder Sample
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Blue Diamond-Victorville
Performance Grade: PG 64-16
Modified:
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: Lunday Thagard Company-World Oil - South Gate CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
