Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000481 DEA: 081C07U4 EFIS: 0824000168
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-74-27.5/34.3
Work Description: RUBBERIZED HMA, FIBER OPTIC CABLE SYSTEMS, AND COLD PLANE AC PAVEMENT.
Location Description: RIVERSIDE COUNTY AT AND NEAR ROMOLAND AND HOMELAND FROM BONNIE DRIVE TO WINCHESTER ROAD
Contractor Name: GRIFFITH COMPANY
Contractor Address: 12200 Bloomfield Avenue, Santa Fe Springs, CA 90670
Resident Engineer: Omar Sanchez Structure Rep.: Unknown
DIME Sample ID: 2026-06-10-35
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: Crumb Rubber Modifier
Sample Taken Date: 06/10/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/12/2026
The quantity of what the sample constitutes: 1 Can of Crum Rubber, 1 Can of Hi-Nat
A brief description of the sample: JMF Verif. 3/4" RHMA-G, 0.5% LAS PG64-16RB
From where was the sample collected: Manufacturer
Laboratory sample identification: 0316G-26
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Martin Marietta - Lake Elsinore
