Sample Record for 2026-03-16-44
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1001468 DEA: 081L2404 EFIS: 0819000167
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-95-R57.2/64.5
Work Description: RHMA (GAP GRADED), REPLACE AC SURFACING, AND COLD PLANE AC PVMT.
Location Description: SAN BERNARDINO COUNTY NEAR NEEDLES FROM ROUTE 40/95 SEPARATION TO 0.5 MILE NORTH OF GOFFS ROAD
Contractor Name: SULLY - MILLER CONTRACTING COMPANY
Contractor Address: 135 S STATE COLLEGE BLVD. 400, BREA, CA 92821
Resident Engineer: Anthony Doan Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2026-03-16-44
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: 03/16/2026
Date that the sample was received by the laboratory/organization performing the testing: 03/19/2026
The quantity of what the sample constitutes: 2 bags comb agg, 2 bags comb RAP
A brief description of the sample: PSU 3/4" HMA A R25 0.6% EVO
From where was the sample collected: Manufacturer
Laboratory sample identification: 0150A-26
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Ingevity/ World Oil/ Calportland Scheer Quary, Agcon Inc
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-36-0046, 91-36-0022
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 at Blue Diamond Victorville Plant
Where the material sample would have been placed if not sampled: Asphalt Paving
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: 300154 R25
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
