Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 209695 DEA: 08347704 EFIS: 0800000616
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-SR-58-0/12.9
Work Description: (Alternative Delivery) The CMGC project will upgrade SR 58 from 2- to 4-lanes in San Bernardino County from the Kern County line to 7.5 miles east of US-395.
Location Description: SR-58 / 395 Kramer Junction project. In San Bernardino County from the Kern County line to 7.5 miles east of US-395.
Contractor Name: KIEWIT INFRASTRUCTURE WEST CO.
Contractor Address: 2215 E 1ST STREET, VANCOUVER, WA 98661
Resident Engineer: Shaine Shahidi Structure Rep.: Osama Abdalla
DIME Sample ID: 2020-06-12-12
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: 06/12/2020
Date that the sample was received by the laboratory/organization performing the testing: 06/15/2020
The quantity of what the sample constitutes: 167 Tons
A brief description of the sample: 3/4" HMA-A R15 PG64-28M (0.75% LAS)
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan-Oro Grande
