Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001669 DEA: 09379004 EFIS: 0919000004
QA Service Level: 1
DIST-CO-RTE-PM: 09-INY-395-R65.0/76.0
Work Description: FULL DEPTH RECYCLING, COLD PLANE, HMA AND CURB RAMPS.
Location Description: INYO COUNTY AT AND NEAR INDEPENDENCE FROM 3 MILES SOUTH OF MANZANAR REWARD ROAD TO 0.3 MILE NORTH OF SHABBELL LANE
Contractor Name: ROAD AND HIGHWAY BUILDERS LLC
Contractor Address: 950 E MUSTANG RD, SPARKS NV 89434
Resident Engineer: Garrett Rottner Structure Rep.: Unknown
DIME Sample ID: 2026-06-18-82
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: Asphalt Modifier
Sample Taken Date: 06/18/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/29/2026
The quantity of what the sample constitutes: 1can
A brief description of the sample: Asphalt Binder Sample
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: TANKER LOAD 3
