Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995169 DEA: 081K4024 EFIS: 0820000074 COOP: 081701
QA Service Level: 2
DIST-CO-RTE-PM: 08-RIV-I-15-3.9
Work Description: Construction of 12 ft wide aux lane with 10 ft right shoulder on northbound I-15. Embankment excavation and construction of retaining wall in front of Santiago Road overcrossing abutment.
Location Description: NB I-15 between Temecula Parkway and Rancho California Road
Contractor Name: BEADOR CONSTRUCTION
Contractor Address: 2900 Bristol Street, Suite D204, Costa Mesa, CA 92626
Resident Engineer: Mike Mohammadi Structure Rep.: Shukri Abouazra
DIME Sample ID: 2024-06-19-101
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: Verification
Type of Material: Hot Mix Asphalt
Sample Taken Date: 06/19/2024
Date that the sample was received by the laboratory/organization performing the testing: 06/26/2024
The quantity of what the sample constitutes: 24 BOXES OF HMA, 4 QTS OF PG64-16, 3 BAGS OF COMBINED AGG, 2 BAGS OF RAP
A brief description of the sample: 3/4" HMA-A-SP 0.25% EVO
From where was the sample collected: Manufacturer
Laboratory sample identification: 0306A-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: R.J. NOBLE - CORONA
