Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002572 DEA: 061H9704 EFIS: 0625000105
QA Service Level: 1
DIST-CO-RTE-PM: 06-MAD-152-R0.0/15.5
Work Description: MADERA COUNTY SLAB REPLACEMENT WITH DIGOUTS ON SR 59, 152. Cold plane AC, remove concrete pavement and place with HMA and RHMA.
Location Description: CONSTRUCTION ON STATE HIGHWAY IN MADERA COUNTY NEAR CHOWCHILLA FROM ROUTE 59/152 SEPARATION TO 0.1 MILE WEST OF ROUTE 99/152 SEPARATION.
Contractor Name: Granite Construction Company (Jorge Velazquez)
Contractor Address: Unknown
Resident Engineer: Alaa Ghoneim Structure Rep.: None None
DIME Sample ID: 2026-09-24-38
TL Number from the TL Form: 047880
Sample Submitted By Organization: CT HQ - Sacramento Hot Mix Asphalt Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Quality Control
Type of Material: Crumb Rubber Modifier
Sample Taken Date: 09/24/2026
Date that the sample was received by the laboratory/organization performing the testing: 09/30/2026
The quantity of what the sample constitutes: 1 Bag of Scrap Tire Crumb Rubber
A brief description of the sample: High Natural - Scrap Tire Rubber Modifier
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Santa Fe Aggregate- Winton
