Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 6357 DEA: 11374704 EFIS: 1100000502 MINOR: 11A1703
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-5-39.8
Work Description: INSTALL TYPE 2 CHAIN LINK RAILING ON BOTH SIDES OF BIRMINGHAM DR
Location Description:
Contractor Name: FRANK MENDINA CONSTRUCTION
Contractor Address: Unknown
Resident Engineer: CAMERON CHAFFEE Structure Rep.: Unknown
DIME Sample ID: 2026-06-15-9
TL Number from the TL Form:
Sample Submitted By Organization: CT D09 - Bishop Field Laboratory
Sample Organization Contact: (760) 872-5211
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 06/15/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/15/2026
The quantity of what the sample constitutes: 750 Tons of 2046.96 Tons
A brief description of the sample: 3/4" HMA Type A PG 70-10
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite five bridges
