Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214921 DEA: 09367404 EFIS: 0916000025
QA Service Level: 1
DIST-CO-RTE-PM: 09-KER-14-R4.7/R12.6
Work Description: CONSTRUCT CRCP OVER EXISTING PAVEMENT AND PLACE HMA.
Location Description: KERN COUNTY AT AND NEAR ROSAMOND AND MOJAVE FROM 1.4 MILES SOUTH OF DAWN ROAD OVERCROSSING TO 0.5 MILE NORTH OF SILVER QUEEN ROAD OVERCROSSING
Contractor Name: Jesus Pena
Contractor Address: 18201 Von Karman, Suite #800, IRVINE CA 92612
Resident Engineer: Hin Hartanto Structure Rep.: Unknown
DIME Sample ID: 2021-04-29-23
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: Department Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 04/29/2021
Date that the sample was received by the laboratory/organization performing the testing: 05/04/2021
The quantity of what the sample constitutes: 4 HMA boxes
A brief description of the sample: 3/4" HMA-A-SP R25 0.8% Dry Lime
From where was the sample collected: Manufacturer
Laboratory sample identification: 0254A-21
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Big Rock , Granite Construction