Sample Record for 2023-04-30-6
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 215109 DEA: 081C8504 EFIS: 0813000047
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-74-0.0/5.8
Work Description: ROADWAY EXCAVATION, HOT MIX ASPHALT, AND STRUCTURAL SHOTCRETE WALLS.
Location Description: RIVERSIDE COUNTY NEAR LAKE ELSINORE FROM ORANGE COUNTY LINE TO MONTE VISTA STREET
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 38000 MONROE STREET, INDIO, CA 92203
Resident Engineer: Osama Abdalla Structure Rep.: Ryan Kash (Reports)
Sample Information
DIME Sample ID: 2023-04-30-6
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: 04/30/2023
Date that the sample was received by the laboratory/organization performing the testing: 05/08/2023
The quantity of what the sample constitutes: 4 Bags of Agg., 2 Bags of RAP
A brief description of the sample: PSUE 3/4" HMA-A-SP
From where was the sample collected: Manufacturer
Laboratory sample identification: 0240A-23
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: California Commercial Asphalt - Lake Elsinore
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-33-0098
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Manufacturer
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: 53417615
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
