Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994589 DEA: 081H4914 EFIS: 0819000118
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-18-53.1/69.0
Work Description: REPLACE AC SURF, HMA (TYPE A), AND COLD CENTRAL PLANT RECYCLING.
Location Description: SAN BERNARDINO COUNTY NEAR BIG BEAR LAKE FROM 0.4 MILE EAST OF PINEVIEW DRIVE TO 0.1 MILE NORTH OF RICHARD STREET AND VISALIA AVENUE
Contractor Name: SULLY-MILLER CONTRACTING COMPANY
Contractor Address: Unknown
Resident Engineer: Alfonso Gonzalez Structure Rep.: Unknown
DIME Sample ID: 2023-09-14-28
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: 09/14/2023
Date that the sample was received by the laboratory/organization performing the testing: 09/18/2023
The quantity of what the sample constitutes: 2 BOXES OF HMA
A brief description of the sample: 3/4" HMA-A-SP R15 0.6% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0478A-23
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Blue Diamond Materials-Victorville
