Sample Record

Owner Lab

  • CT D08 - Fontana Southern Regional Laboratory

DIME Sample ID 2025-12-20-3

Project Information

Project IdentifiersProject ID: 1001850
DEA: 081T3304
EFIS: 0826000040
DIST-CO-RTE-PM08-SBD-38-
Award DateNot set
Closeout DateNot set
Work DescriptionNot set
Location DescriptionNot set
QA Service Level1 (Verified on 11/26/2025)

Sample Information

Sample Taken Date12/20/2025 Sample Unique Key3
Will the laboratory/organization for which you are a member perform testing on this material sample?Yes Date that the sample was received by the laboratory/organization performing the testing12/23/2025
Sample typeVerification A brief description of the samplePSUE 3/4" HMA-A- SP R20% EVO 0.5%
The quantity of what the sample constitutes3 bags comb agg, 1 bag EA RAP (Coarse and Fine) From where was the sample collectedManufacturer
First name of sampler or witnessed byIdris Last name of sampler or witnessed byNajjar
Title of sampler Telephone number of sampler
Laboratory sample identification0703A-25 Linked DIME Sample ID
The fabricator/manufacturer/facility nameValero, Ingevity, Cemex Lytle Creek Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form Structure unique identifier
Structure name Bid ItemNot set

Material Information

Material TypeAggregate Source Identification (SMARA, name of Pit or Job Site)91-36-0040
The fabricator's/manufacturer's product name for the sample The fabricator/manufacturer designation for the sample
The plant number A detailed description of where the material sample was collectedBelt Cut at Matich Lytle Creek Plant
Where the material sample would have been placed if not sampledAsphalt Paving Primary Aggregate Nominal Size3/4 inch
The concrete mix design numberB6Z Lot number
Sublot number Aggregate Mix Number

Submitted Tests

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