Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001098 DEA: 081P0804 EFIS: 0823000089
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-10-7.0/44.5
Work Description: FURNISH & PLACE POLYESTER CONCRETE OVERLAY, JOINT SEAL, HMA (BRIDGE).
Location Description: RIVERSIDE COUNTY AT VARIOUS LOCATIONS FROM VEILE AVENUE UNDERCROSSING IN BEAUMONT TO MONTEREY AVENUE OVERCROSSING AT THOUSAND PALMS
Contractor Name: TRUESDELL CORPORATION OF CALIFORNIA, INC.
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2026-02-17-12
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: Aggregate
Sample Taken Date: 02/17/2026
Date that the sample was received by the laboratory/organization performing the testing: 02/20/2026
The quantity of what the sample constitutes: 3 bags of 1/2", 3 bags of 3/8", 3 bags of Rock-dust, 3 bags of Comb RAP, 1 bag of Mineral filler
A brief description of the sample: JMF Verification
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Martin Marietta
Source Identification (SMARA, name of Pit or Job Site): 19-33-0084
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Belt cut
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number: 41217195WM
Lot number:
Sublot number:
Aggregate Mix Number: 41217195WM
