Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213551 DEA: 080K2934 EFIS: 0812000100
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-10-R36.8/R39.2
Work Description: PAVEMENT REHABILITATION AND CONTINUOUSLY REINFORCED CONCRETE PAVEMENT
Location Description: SAN BERNARDINO COUNTY IN YUCAIPA FROM 0.2 MILE WEST OF LIVE OAK CANYON ROAD TO COUNTY LINE ROAD UNDERCROSSING
Contractor Name: Coffman Specialties
Contractor Address: 9685 Via Excelencia, San Diego, CA 92126
Resident Engineer: Ezz Gayed Structure Rep.: Unknown
DIME Sample ID: 2020-07-01-16
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: 07/01/2020
Date that the sample was received by the laboratory/organization performing the testing: 07/01/2020
The quantity of what the sample constitutes: 2311 Tons
A brief description of the sample: 3/4" HMA R12 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: Matich-Cabazon
