Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994599 DEA: 081N1604
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-40-R20.0/R28.1
Work Description: RHMA, HIGH DENSITY POLYURETHANE INJECTION, AND COLD PLANE AC PVMT.
Location Description: SAN BERNARDINO COUNTY NEAR BARSTOW FROM 0.3 MILE WEST OF NEWBERRY ROAD OVERCROSSING TO DESERT OASIS REST AREA
Contractor Name: SULLY-MILLER CONTRACTING COMPANY
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2023-09-26-64
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: 09/26/2023
Date that the sample was received by the laboratory/organization performing the testing: 10/18/2023
The quantity of what the sample constitutes: 3 BOXES OF 100% RAP HMA
A brief description of the sample: 100% RAP HMA
From where was the sample collected: Manufacturer
Laboratory sample identification: 0526-23
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: COLTON
