Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000665 DEA: 081K4004 EFIS: 0819000031
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-15-3.5/6.8
Work Description: HMA (TYPE A), RDWY EXC, STR CONC RET WALL, RUBBERIZED HMA (OGFC).
Location Description: TEMECULA FROM 0.1 MI NORTH OF TEMECULA PARKWAY TO 0.2 MI NORTH OF WINCHESTER ROAD
Contractor Name: BEADOR CONSTRUCTION COMPANY, INC.
Contractor Address: 2900 Bristol Street, Suite D204, Costa Mesa, CA 92626
Resident Engineer: Denise Sostrom Structure Rep.: Gizachew Abayneh
DIME Sample ID: 2026-01-13-28
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: Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 01/13/2026
Date that the sample was received by the laboratory/organization performing the testing: 01/20/2026
The quantity of what the sample constitutes: 4 boxes
A brief description of the sample: HMA Type A
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RJ Noble Company
HMA Type: Type A HMA
HMA Grading: 3/4 inch
Lot number:
Sublot number:
HMA Mix Number: 36R2508SPWEC
Binder content (%): 4.6
Virgin binder PG:
Design binder PG: PG 70-10
Binder Supplier: World Oil
RAP content (%): 25
WMA Additives: Yes
Antistrip type: Evotherm
