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: 2026-07-14-79
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: 07/14/2026
Date that the sample was received by the laboratory/organization performing the testing: 07/17/2026
The quantity of what the sample constitutes: 824.16
A brief description of the sample: 3/4" RHMA-G
From where was the sample collected: Manufacturer
Laboratory sample identification: 0417G-26
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Martin Mariatta Lake Elsinore
