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: 2024-07-10-64
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: Verification
Type of Material: Asphalt Modifier
Sample Taken Date: 07/10/2024
Date that the sample was received by the laboratory/organization performing the testing: 07/12/2024
The quantity of what the sample constitutes: 1can
A brief description of the sample: Asphalt Binder Sample
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA-Corona
