Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995494 DEA: 081K4904 EFIS: 0819000050
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-40-R105.1/R105.9
Work Description: BUILDING WORK, HMA, AND TEMPORARY PORTABLE SANITARY FACILITIES.
Location Description: SAN BERNARDINO COUNTY ABOUT 36 MILES WEST OF NEEDLES FROM 2.1 MILES TO 1.3 MILES WEST OF GOFFS ROAD UNDERCROSSING
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 38000 Monroe Street, Indio, CA 92203
Resident Engineer: Anthony Doan Structure Rep.: Alejandrino Naime
DIME Sample ID: 2024-08-21-25
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: Verification
Type of Material: Hot Mix Asphalt
Sample Taken Date: 08/21/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/22/2024
The quantity of what the sample constitutes: 24 BOX HMA, 6 QT OIL, 2 QT EVO, 2 QT LIME, 4 BAG CMB AGG, 3 BAG 3/4, 1/2, 3/8, 2 BAG RD, RAP2 BAG FS
A brief description of the sample: 3/4" WMA A SP R25 1% LSM
From where was the sample collected: Manufacturer
Laboratory sample identification: 0421A-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Desert Hot Springs
