Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993609 DEA: 09388804 EFIS: 0921000038
QA Service Level: 1
DIST-CO-RTE-PM: 09-KER-58-R123.0/R125.3
Work Description: COLD PLANE AC PAVEMENT AND PLACE RHMA-G.
Location Description: IN KERN COUNTY ABOUT 10 MILES EAST OF MOJAVE FROM 4.6 MILES TO 2.3 MILES WEST OF CALIFORNIA CITY BOULEVARD
Contractor Name: GRIFFITH COMPANY
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2022-08-12-39
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: 08/12/2022
Date that the sample was received by the laboratory/organization performing the testing: 09/13/2022
The quantity of what the sample constitutes: 2 BOXES 750 TONS OUT
A brief description of the sample: 3/4" HMA-A-SP R15 1.0% LSM
From where was the sample collected: Manufacturer
Laboratory sample identification: 0632A-22
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Griffith Edmonston-Lebec
