Sample Record for 2021-08-20-40
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 215587 DEA: 081L6804 EFIS: 0820000138
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-91,15-7.5/13.4,8.2/23.9
Work Description: SLAB REPLACEMENT, PLACE SLURRY SEAL AND REPLACE AC SURFACING.
Location Description: RIVERSIDE COUNTY IN AND NEAR CORONA AND MURRIETA ON ROUTE 91 FROM ROUTE 15/91 SEPARATION TO 0.4 MILE EAST OF TYLER STREET AND ON ROUTE 15 FROM 1.5 MILES NORTH OF WINCHESTER ROAD TO NICHOLS ROAD
Contractor Name: RV Concrete
Contractor Address: 605 E Commercial Street, Anaheim, CA 92801
Resident Engineer: Denise Sostrom Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2021-08-20-40
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: Aggregate
Sample Taken Date: 08/20/2021
Date that the sample was received by the laboratory/organization performing the testing: 09/09/2021
The quantity of what the sample constitutes: 4 Bags of Combined Aggregate, 4 Bags of RAP
A brief description of the sample: JMF 3/4" WMA-A-SP R15, 0.4% Evotherm
From where was the sample collected: Manufacturer
Laboratory sample identification: 0522A-21
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: All American Asphalt Corona
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-33-0005
The fabricator's/manufacturer's product name for the sample: 3/4 WMA-A-SP R15
The fabricator/manufacturer designation for the sample:
The plant number: 103793
A detailed description of where the material sample was collected: Belt Cut at All American Corona Plant
Where the material sample would have been placed if not sampled: Asphalt Paving
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
