Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214848 DEA: 081H3414 EFIS: 0818000172
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-210,215,259-Various
Work Description: PLACE RHMA-G, COLD PLANE AC AND REPLACE AC SURFACING.
Location Description: SAN BERNARDINO COUNTY ON ROUTE 210, 215 AND 259 AT VARIOUS LOCATIONS
Contractor Name: All American Asphalt
Contractor Address: 400 E. 6th Street, PO Box 2229, Corona, CA 92878-2229
Resident Engineer: Rambod Sufipur Structure Rep.: Unknown
DIME Sample ID: 2022-04-09-23
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Barstow Field Laboratory 1
Sample Organization Contact: (760) 252-9216
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 04/09/2022
Date that the sample was received by the laboratory/organization performing the testing: 04/13/2022
The quantity of what the sample constitutes: 1
A brief description of the sample: 34" cores
From where was the sample collected: Job Site
Laboratory sample identification: 2B
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: All American Asphalt Corona
