Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001641 DEA: 030J4004 EFIS: 0319000280
QA Service Level: 1
DIST-CO-RTE-PM: 03-ED-50-18.7/22.9
Work Description: COLD PLANE AC PVMT, HMA, RCP, CONC BARRIER, & STRUCTURAL CONC.
Location Description: EL DORADO COUNTY IN AND NEAR PLACERVILLE FROM 0.1 MILE WEST OF CARSON ROAD OVERCROSSING TO 5 MILE ROAD AND FROM 1.0 MILE EAST OF CAMINO HEIGHTS ROAD TO 0.3 MILE EAST OF RIDGEWAY DRIVE UNDERCROSSING
Contractor Name: GRANITE CONSTRUCTION
Contractor Address: 4001 BRADSHAW ROAD, SACRAMENTO, CA 95827
Resident Engineer: Nathan Alterton Structure Rep.: Unknown
DIME Sample ID: 2026-08-25-32
TL Number from the TL Form:
Sample Submitted By Organization: Blackburn Consulting
Sample Organization Contact: (916) 375-8706
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 08/25/2026
Date that the sample was received by the laboratory/organization performing the testing: 08/26/2026
The quantity of what the sample constitutes: 2 Boxes
A brief description of the sample: 3/4" HMA64-16R25
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Bradshaw
