Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213638 DEA: 081E4604 EFIS: 0814000026
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-74-37.7/44.7
Work Description: CONSTRUCT RAISED MEDIAN CURBS AND LEFT TURNS, AND WIDEN SHOULDERS.
Location Description: RIVERSIDE COUNTY IN AND NEAR HEMET FROM 0.1 MILE WEST OF WEST ACACIA AVENUE TO RAMONA EXPRESSWAY
Contractor Name: AUTOBAHN CONSTRUCTION INC.
Contractor Address: 933 N Batavia St Ste A, Orange, CA 92867
Resident Engineer: Nick Truong Structure Rep.: Unknown
DIME Sample ID: 2020-06-22-30
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: 06/22/2020
Date that the sample was received by the laboratory/organization performing the testing: 06/23/2020
The quantity of what the sample constitutes: 100 Tons
A brief description of the sample: 3/4" HMA-A R15 PG64-28M (0.50% LAS)
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan-Corona
