Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214314 DEA: 081F6904 EFIS: 0815000016
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-79-0.0/15.6
Work Description: COLD PLANE AC PAVEMENT AND PLACE RHMA-G.
Location Description: RIVERSIDE COUNTY NEAR TEMECULA FROM SAN DIEGO COUNTY LINE TO 0.4 MILE EAST OF BUTTERFIELD STAGE ROAD
Contractor Name: All American Asphalt
Contractor Address: P.O. Box 2229, Corona CA, 92878
Resident Engineer: Osama Abdalla Structure Rep.: Unknown
DIME Sample ID: 2020-06-03-12
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: Department Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 06/03/2020
Date that the sample was received by the laboratory/organization performing the testing: 06/04/2020
The quantity of what the sample constitutes: 1505 Tons
A brief description of the sample: 3/4" RHMA-G PG64-16RB (0.5% LAS)
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA-Corona
