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: 2026-09-20-19
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: Asphaltic Emulsion
Sample Taken Date: 09/20/2026
Date that the sample was received by the laboratory/organization performing the testing: 09/25/2026
The quantity of what the sample constitutes: 16 Boxes,2 bags,2qt can
A brief description of the sample: Emulsion- MSE
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: DISTRIBTOR TRUCK
