Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001153 DEA: 081L3104 EFIS: 0820000020
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-74-11.8/17.3
Work Description: RHMA (GAP GRADED), REPLACE AC SURF, AND COLD PLANE AC PVMT.
Location Description: RIVERSIDE COUNTY IN LAKE ELSINORE FROM GRAND AVENUE TO ROUTE 15/74 SEPARATION
Contractor Name: R.J. NOBLE COMPANY
Contractor Address: Unknown
Resident Engineer: Xavier Avila Structure Rep.: Unknown
DIME Sample ID: 2026-03-25-40
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: 03/25/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/03/2026
The quantity of what the sample constitutes: 4 bags comb agg, 1 bag EA (coarse and fine RAP)
A brief description of the sample: PSUE 3/4" HMA-A-SP R25 0.25% EVO
From where was the sample collected: Manufacturer
Laboratory sample identification: 0170A-26
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: World Oil, Ingevity, Martin Marietta, Mayhew
Source Identification (SMARA, name of Pit or Job Site): 91-33-0014
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 RJ Noble Corona 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: 36R2508SPWEC
Lot number:
Sublot number:
Aggregate Mix Number:
