Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002458 DEA: 09428604 EFIS: 0925000087
QA Service Level: 1
DIST-CO-RTE-PM: 09-UNKNOWN--unknown
Work Description:
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Daniel Enriquez Structure Rep.: Unknown
DIME Sample ID: 2026-09-02-55
TL Number from the TL Form:
Sample Submitted By Organization: CT D09 - Bishop Field Laboratory
Sample Organization Contact: (760) 872-5211
Type of Sample: Production Start-Up
Type of Material: Hot Mix Asphalt
Sample Taken Date: 09/02/2026
Date that the sample was received by the laboratory/organization performing the testing: 09/08/2026
The quantity of what the sample constitutes: 8 Boxes HMA PSU
A brief description of the sample: 3/4” PG 64-28M
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Griffith Edmonston-Lebec
