Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994602 DEA: 09392004 EFIS: 0922000036
QA Service Level: 1
DIST-CO-RTE-PM: 09-INY-395-44.9/50.9,52.9/54.5
Work Description: HOT MIX ASPHALT (TYPE-A), SHOULDER BACKING, AND STRIPING.
Location Description: INYO COUNTY NEAR LONE PINE FROM 1.3 MILES SOUTH OF COTTONWOOD ROAD TO 2 MILES NORTH OF BARTLETT ROAD AND FROM 0.3 MILE SOUTH OF LUBKEN CANYON ROAD TO 1.1 MILES SOUTH OF GOLF COURSE ROAD
Contractor Name: SULLY-MILLER CONTRACTING COMPANY
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2023-07-24-16
TL Number from the TL Form:
Sample Submitted By Organization: CT D09 - Bishop Field Laboratory
Sample Organization Contact: (760) 872-5211
Type of Sample: Department Acceptance
Type of Material: Reclaimed Asphalt Pavement
Sample Taken Date: 07/24/2023
Date that the sample was received by the laboratory/organization performing the testing: 07/25/2023
The quantity of what the sample constitutes: 1 Bag
A brief description of the sample: RAP
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Sully-Miller Blue Diamond Plant
