Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000889 DEA: 081M7404 EFIS: 0822000036
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-210-1.2/1.6
Work Description: JPCP (RSC), RDWY EXC, LCB RAPID SETTING, & HMA (TYPE A).
Location Description: SANBERNARDINO COUNTY IN UPLAND FROM 0.3 MILE WEST TO 0.1 MILE EAST OF MOUNTAIN AVENUE OVERCROSSING
Contractor Name: INTERSTATE CIVIL CONSTRUCTION
Contractor Address: PO Box 2819, Wrightwood, CA 92397
Resident Engineer: Vu T. Nguyen Structure Rep.: Unknown
DIME Sample ID: 2025-07-17-161
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Sample Organization Contact: 9512323690
Type of Sample: Acceptance
Type of Material: Soil
Sample Taken Date: 07/17/2025
Date that the sample was received by the laboratory/organization performing the testing: 07/17/2025
The quantity of what the sample constitutes: 25.9 kg
A brief description of the sample: Native Subgrade
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CTM 231 TEST LOCATION
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: SR-210 WB Right Shoulder near Mountain Ave Overcrossing Bridge, Sta 398+70 - 403+95
Where the material sample would have been placed if not sampled:
DIME Test ID: 2025-07-17-161-1
Test Method: CTM 231-March 2013: Method of Test for Relative Compaction of Untreated and Treated Soils and Aggregates Using Nuclear Gages
Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: prakash.gowda@dot.ca.gov
Organization Phone: (951) 232-3690
Data has not been verified.
