Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002589 DEA: 112N2354 EFIS: 1124000193
QA Service Level: 1
DIST-CO-RTE-PM: 11-SAN DIEGO-76-R8.1/R12.0
Work Description: RTE 76 REHAB - OCEANSIDE, 0.4 MI E OF MELROSE DR TO OLIVE HILL RD/CAMINO DEL REY (11-2N2354)
Location Description:
Contractor Name: CALMEX ENGINEERING INC.
Contractor Address: 2750 Lilac Ave, Bloomington, CA 92316
Resident Engineer: Fahad Masud Structure Rep.: Unknown
DIME Sample ID: 2026-09-08-51
TL Number from the TL Form:
Sample Submitted By Organization: CT D11 - District 11 Materials Laboratory
Sample Organization Contact: (858) 518-8709
Type of Sample: Production Start-Up
Type of Material: Aggregate
Sample Taken Date: 09/08/2026
Date that the sample was received by the laboratory/organization performing the testing: 09/09/2026
The quantity of what the sample constitutes: 4 Bags
A brief description of the sample: 3/4" HMA-A
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: All American Asphalt Corona
Source Identification (SMARA, name of Pit or Job Site): See mix
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: plant
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: 105793
Lot number:
Sublot number:
Aggregate Mix Number:
