Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213970 DEA: 080K1214 EFIS: 0815000245
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15-12.5/14.8
Work Description: REPLACE PCC PAVEMENT WITH JPCP AND PRECAST JOINTED CONCRETE PAVEMENT.
Location Description: SAN BERNARDINO COUNTY IN FONTANA AND NEAR DEVORE FROM 0.3 MILE SOUTH OF SIERRA AVENUE UNDERCROSSING TO GLEN HELEN PARKWAY UNDERCROSSING
Contractor Name: OHL USA, INC
Contractor Address: 1920 MAIN STREET STE 310, Irvine, CA 92614
Resident Engineer: Vu Thanh Nguyen Structure Rep.: Unknown
DIME Sample ID: 2020-12-01-19
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Hesperia Field Testing Laboratory
Sample Organization Contact: (951) 840-8242
Type of Sample: Acceptance
Type of Material: Rapid Set
Sample Taken Date: 12/01/2020
Date that the sample was received by the laboratory/organization performing the testing: 12/01/2020
The quantity of what the sample constitutes: 2
A brief description of the sample: Type II
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Robertsons Rialto
