Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994191 DEA: 081G8304 EFIS: 0816000079
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-40-R100.8/R101.8
Work Description: HMA, STRUCTURAL CONC, BAR REINFORCING STEEL, CRSP & IMPORTED BORROW.
Location Description: SAN BERNARDINO COUNTY AT ESSEX FROM 1.1 MILES EAST OF ESSEX ROAD OVERCROSSING TO 0.5 MILE EAST OF HALFWAY HILLS WASH BRIDGE
Contractor Name: SKANSKA USA CIVIL WEST CALIFORNIA DISTRICT INC.
Contractor Address: 1995 Agua Mansa Rd, Riverside, CA 92509
Resident Engineer: Anthony Doan Structure Rep.: Jegbefume Adodo
DIME Sample ID: 2023-09-19-55
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Barstow Field Laboratory 1
Sample Organization Contact: (760) 252-9216
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 09/19/2023
Date that the sample was received by the laboratory/organization performing the testing: 09/27/2023
The quantity of what the sample constitutes: 1 core
A brief description of the sample: 1" HMA A
From where was the sample collected: Manufacturer
Laboratory sample identification: L1 SL 6 6A
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Sully Miller
DIME Test ID: 2023-09-19-55-1
Test Method: AASHTO T275-07r12: Standard Method of Test for Bulk Specific Gravity (Gmb) of Compacted Asphalt Mixtures Using Paraffin-Coated Specimens (Bulk Specific Gravity)
Submitted By Organization: CT D08 - Barstow Field Laboratory 1
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: kaushalkumar.talati@dot.ca.gov
Organization Phone: (951) 840-8328
Data has not been verified.
