Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214466 DEA: 081F1414 EFIS: 0815000231
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-15-15-54.2/54.3
Work Description: Slab & lane replacement with JPCP & precast conc pavement, place HMA.
Location Description: Riverside and San Diego County
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 3075 Townsgate Road, Suite 200, Westlake Village, CA 91361
Resident Engineer: Mike Bergevin Structure Rep.: Unknown
DIME Sample ID: 2021-07-23-10
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: Asphalt Rubber Binder
Sample Taken Date: 07/23/2021
Date that the sample was received by the laboratory/organization performing the testing: 07/26/2021
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: 0428-21
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CCA-Lake Elsinore
Asphalt modifier supplier:
Performance Grade: PG 64-16
Lot number:
Sublot number:
Asphalt Rubber Binder Mix Number:
