Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000777 DEA: 07370404 EFIS: 0720000128
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-5-R59.5/R73.7
Work Description: COLD PLANE AC PAVEMENT, PLACE HOT MIX ASPHALT AND INSTALL MGS.
Location Description: LOS ANGELES COUNTY FROM LAKE HUGHES ROAD UNDERCROSSING TO 0.7 MILE SOUTH OF VISTA DEL LAGO ROAD OVERCROSSING.
Contractor Name: GRIFFITH COMPANY
Contractor Address: 1128 Carrier Parkway Avenue, Bakersfield, CA 93308
Resident Engineer: Ridwan Salman Structure Rep.: Unknown
DIME Sample ID: 2026-07-08-76
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: Acceptance
Type of Material: Aggregate
Sample Taken Date: 07/08/2026
Date that the sample was received by the laboratory/organization performing the testing: 07/16/2026
The quantity of what the sample constitutes: 10 Bags Agg. 3/4",1/2",3/8" 2 bags ea. RD, WRD, 3 bags of Comb Belt Cut, 1 Quart CR, 1 Quart Hi-Nat
A brief description of the sample: 3/4" RHMA G SP 1.o% LSM
From where was the sample collected: Manufacturer
Laboratory sample identification: 0414G-26
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Griffith Edmonston
Source Identification (SMARA, name of Pit or Job Site): 91-15-0068
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: GRF-23-34 RHMA-LSM
Lot number:
Sublot number:
Aggregate Mix Number:
DIME Test ID: 2026-07-08-76-1
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: (213) 792-4797
Data has not been verified.
DIME Test ID: 2026-07-08-76-2
Test Method: AASHTO T176-08: Standard Method of Test for Plastic Fines in Graded Aggregates and Soils by Use of the Sand Equivalent Test (Sand Equivalent)
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: (213) 792-4797
Data has not been verified.
