Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002813 DEA: 081N6604 EFIS: 0823000030
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-62-33.6/38.5
Work Description: Rubberized HMA and partial depth recycling
Location Description: CONSTRUCTION ON STATE HIGHWAY IN SAN BERNARDINO COUNTY IN TWENTYNINE PALMS FROM ATHOL AVENUE TO GOPHER GROVE LANE.
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2026-11-02-9
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: Crumb Rubber Modifier
Sample Taken Date: 11/02/2026
Date that the sample was received by the laboratory/organization performing the testing: 11/02/2026
The quantity of what the sample constitutes: 6 Bags of 1/2", 3/8", & Fine Agg (2 ea), 1 Bag of Crum Rubber, 1 Bag of Hi-Nat
A brief description of the sample: 1/2" RHMA-G R00 0.5% Morelife 5000
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Martin Marietta-Coachella
