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: 2024-05-22-63
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: Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 05/22/2024
Date that the sample was received by the laboratory/organization performing the testing: 05/28/2024
The quantity of what the sample constitutes: 2 boxes of hma, 1 qt of oil
A brief description of the sample: 1" HMA-A-SP R25 1% LSM
From where was the sample collected: Manufacturer
Laboratory sample identification: 0264A-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Blue Diamond Materials-Victorville
