Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994443 DEA: 053307C4 EFIS: 0514000028
QA Service Level: 1
DIST-CO-RTE-PM: 05-SLO-41,46-44.5/45.3,54.0/57.8
Work Description: Wye Segment - Route 41/46 Separation
Location Description:
Contractor Name: Atkinson Construction
Contractor Address: 18201 Von Karman - Suite 800, Irvine, CA 92612
Resident Engineer: Brian Harrington Structure Rep.: Dave Lewis
DIME Sample ID: 2026-04-14-52
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: Dispute Resolution
Type of Material: Aggregate
Sample Taken Date: 04/14/2026
Date that the sample was received by the laboratory/organization performing the testing: 05/21/2026
The quantity of what the sample constitutes: 1 bag of Cold feed, 1 bag of Comb. RAP
A brief description of the sample: Dispute: 3/4" HMA_SP R25 PG 58-16
From where was the sample collected: Manufacturer
Laboratory sample identification: 0250A-26
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Santa Maria-Solari
Source Identification (SMARA, name of Pit or Job Site): 91-15-0114
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 Plant
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: 14609
Lot number: 8
Sublot number: 9
Aggregate Mix Number:
DIME Test ID: 2026-04-14-52-1
Test Method: AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)
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.
