Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000402 DEA: 11430384 EFIS: 1118000114
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-805-23.7/28.5
Work Description: REPLACE DRAINAGE, CONCRETE PAVEMENT, AND MODIFY ELECTRICAL SYSTEMS.
Location Description: SAN DIEGO COUNTY IN SAN DIEGO FROM 0.1 MILE NORTH OF ROUTE 805/52 SEPARATION TO ROUTE 5/805 SEPARATION
Contractor Name: HAZARD CONSTRUCTION ENGR, LLC
Contractor Address: 10529 VINE STREET, LAKESIDE, CA 92040
Resident Engineer: Karl Hartline Structure Rep.: Unknown
DIME Sample ID: 2026-01-15-5
TL Number from the TL Form:
Sample Submitted By Organization: CT D11 - District 11 Materials Laboratory
Sample Organization Contact: (858) 518-8709
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 01/15/2026
Date that the sample was received by the laboratory/organization performing the testing: 01/15/2026
The quantity of what the sample constitutes: 2 boxes
A brief description of the sample: Normal Production
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Otay
HMA Type: Type A HMA
HMA Grading: 1/2 inch
Lot number:
Sublot number:
HMA Mix Number: 320200 Otay Val
Binder content (%): 4.9
Virgin binder PG: PG58-16
Design binder PG: PG 64-16
Binder Supplier: Valero
RAP content (%): 22
WMA Additives: No
Antistrip type: None
