Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214111 DEA: 081J5604
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-15,74,79-VAR.
Work Description: REPLACE AC SURFACING AND PLACE RHMA-G.
Location Description: RIVERSIDE COUNTY AT VARIOUS LOCATIONS
Contractor Name: All American Asphalt
Contractor Address: 400 E. 6th St., Corona, CA 92879
Resident Engineer: Mike Bergevin Structure Rep.: Unknown
DIME Sample ID: 2019-09-19-19
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: 09/19/2019
Date that the sample was received by the laboratory/organization performing the testing: 09/19/2019
The quantity of what the sample constitutes: 2 boxes
A brief description of the sample: 3/4" RHMA-G PG 64-16 RB
From where was the sample collected: Manufacturer
Laboratory sample identification: 0553G-19
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: All American Asphalt Corona
