Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
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
DIME Sample ID: 2026-04-13-31
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Barstow Field Laboratory 1
Sample Organization Contact: (760) 252-9216
Type of Sample: Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 04/13/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/13/2026
The quantity of what the sample constitutes: HMA boxes, Agg bag
A brief description of the sample: 3/4" RHMA Type - G
From where was the sample collected: Manufacturer
Laboratory sample identification: 0190G-26
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Blue Diamond-Victorville
