Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215148 DEA: 081E8404 EFIS: 0814000113
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV,SBD-62-R6.7/9.2,0.0/15.1,29.3/33.6
Work Description: REPLACE ROADWAY WITH RHMA-G AND HMA.
Location Description: IN RIVERSIDE AND SAN BERNARDINO COUNTIES IN AND NEAR YUCCA VALLEY AND IN TWENTYNINE PALMS FROM 0.2 MILE NORTH OF INDIAN CANYON DRIVE TO 0.6 MILE WEST OF UTAH TRAIL
Contractor Name: Matich Corporation
Contractor Address: P.O. Box 50,000, San Bernardino, CA 92412
Resident Engineer: Khoi Vu Structure Rep.: Unknown
DIME Sample ID: 2021-06-04-15
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: Asphalt Rubber Binder
Sample Taken Date: 06/04/2021
Date that the sample was received by the laboratory/organization performing the testing: 06/08/2021
The quantity of what the sample constitutes: 1 Quart Can
A brief description of the sample: Asphalt Rubber Binder
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Matich-Cabazon
Asphalt modifier supplier:
Performance Grade: PG 64-16
Lot number:
Sublot number:
Asphalt Rubber Binder Mix Number:
