Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001213 DEA: 11431644 EFIS: 1122000232
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-78-N17.7
Work Description: Cold plane, RHMA overlay, Concrete Barriers, Landscape and Electrical.
Location Description: IN SAN DIEGO COUNTY FROM ROUTE 78/5 SEPARATION TO 0.3 MILE EAST OF ESCONDIDO BOULEVARD UNDERCROSSING.
Contractor Name: Skanska USA Civil West
Contractor Address: 1995 Agua Mansa Rd., Riverside, CA 92509
Resident Engineer: Yong Pak Structure Rep.: Carlos Lopez
DIME Sample ID: 2026-08-27-58
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: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 08/27/2026
Date that the sample was received by the laboratory/organization performing the testing: 08/11/2026
The quantity of what the sample constitutes: 4 boes
A brief description of the sample: 1/2" RHMA-G
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RJ Noble Corona
