Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994586 DEA: 081C08U4 EFIS: 0822000142
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-10-R134.0/R156.5
Work Description: PLACE HMA (TYPE A), JPCP, IMPORTED BORROW, ROADWAY EXCAVATION & CL2 AB
Location Description: RIVERSIDE COUNTY FROM 1.1 MILES WEST OF WILEY WELL ROAD OVERCROSSING TO CALIFORNIA/ARIZONA STATE LINE
Contractor Name: FISHER SAND & GRAVEL CO.
Contractor Address: 19062 San Jose Avenue, LA Puente, CA 91748
Resident Engineer: Ryan Espoy (cc on Reports) Structure Rep.: Tim Flores
DIME Sample ID: 2025-11-14-25
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: 11/14/2025
Date that the sample was received by the laboratory/organization performing the testing: 11/17/2025
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: Fisher Sand and Gravel-Tempe
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:
DIME Test ID: 2025-11-14-25-3
Test Method: AASHTO T51-22: Standard Method of Test for Ductility of Asphalt Materials (Asphalt Binder)
Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: (909) 829-3029
Data has not been verified.
