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Sample Record for 2020-05-13-14

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 214140 DEA: 081J1104 EFIS: 0817000211 QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-10,79,86-Var
Work Description: REMOVE, PREPARE AND FURNISH POLYESTER CONCRETE OVERLAY.
Location Description: RIVERSIDE COUNTY AT VARIOUS LOCATIONS
Contractor Name: VELARDE CONCRETE CONSTRUCTION INC
Contractor Address: 523 S BRAND BLVD #201, SAN FERNANDO CA 91340
Resident Engineer: Khoi Vu Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2020-05-13-14
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: 05/13/2020
Date that the sample was received by the laboratory/organization performing the testing: 05/14/2020
The quantity of what the sample constitutes: 161 Tons
A brief description of the sample: 1-2" HMA-A R15 PG-28M (0.50 LAS)
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CCA Coachella

Material Information

HMA Type: Type A HMA
HMA Grading: 1/2 inch
Lot number: Unknown
Sublot number: Unknown
HMA Mix Number:

Test Results