Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994944 DEA: 081J2304 EFIS: 0818000002
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-60-R1.0/12.0
Work Description: RAMP METERING SYSTEM, HMA (TYPE A), RDWY EXC, MOD SIGNAL & LTG SYSTEMS
Location Description: RIVERSIDE COUNTY IN AND NEAR JURUPA VALLEY AND RIVERSIDE AT VARIOUS LOCATIONS FROM WINEVILLE ROAD UNDERCROSSING TO 0.2 MILE WEST OF ROUTE 60/91 SEPARATION
Contractor Name: POWELL CONSTRUCTORS INC
Contractor Address: 8555 BANANA AVE, FONTANA, CA 92335
Resident Engineer: Mahfual Alam Structure Rep.: Unknown
DIME Sample ID: 2024-04-26-25
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: 04/26/2024
Date that the sample was received by the laboratory/organization performing the testing: 05/03/2024
The quantity of what the sample constitutes: 2 BOXES OF HMA, 1BAG OF RAP
A brief description of the sample: 3/4" HMA-A-SP R15
From where was the sample collected: Manufacturer
Laboratory sample identification: 0221A-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: All American Asphalt Corona
