Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 210569 DEA: 083555V4 EFIS: 0814000086
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15-42.5/46.0
Work Description: WIDEN I-15, RECONSTRUCT 3 IC'S, CONSTRUCT 2 NEW BR AND WIDEN 3 BR.
Location Description: SAN BERNARDINO COUNTY IN VICTORVILLE FROM 0.5 MILE NORTH OF MOJAVE DRIVE TO 1.5 MILE NORTH OF STODDARD WELLS ROAD OVERCROSSING
Contractor Name: Ames Construction
Contractor Address: 2000 AMES DRIVE, BURNSVILLE, MN 55306
Resident Engineer: Taghreed Al-Khateeb Structure Rep.: Ravinder Singh
DIME Sample ID: 2019-11-01-14
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: 11/01/2019
Date that the sample was received by the laboratory/organization performing the testing: 11/05/2019
The quantity of what the sample constitutes: 2 boxes
A brief description of the sample: 1" HMA-A R15 PG 64-28M (1.0% Lime Slurry)
From where was the sample collected: Manufacturer
Laboratory sample identification: 0678A-19
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Blue Diamond-Victorville
DIME Test ID: 2019-11-01-14-1
Test Method: AASHTO T308-10: Standard Method of Test for Determining the Asphalt Binder Content of Hot Mix Asphalt (HMA) by the Ignition Method (Asphalt Binder Content)
Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: 9098293029
Data has not been verified.