Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215494 DEA: 081H4904 EFIS: 0817000059
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-18-31.9/38.5
Work Description: COLD PLANE AC PAVEMENT AND OVERLAY WITH HMA (TYPE A).
Location Description: SAN BERNARDINO COUNTY FROM 0.1 MILE EAST OF HILLTOP CONNECTOR TO 0.5 MILE EAST OF SIBERIA CREEK TRAIL
Contractor Name: Matich Corp
Contractor Address: P.O. Box 10, Highland, CA 92346-1010
Resident Engineer: Nhan Nguyen Structure Rep.: Unknown
DIME Sample ID: 2021-08-11-7
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Sample Organization Contact: 9512323690
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 08/11/2021
Date that the sample was received by the laboratory/organization performing the testing: 08/12/2021
The quantity of what the sample constitutes: 2 bags combine aggregate
A brief description of the sample: 3/4" HMA-A-R12
From where was the sample collected: Manufacturer
Laboratory sample identification: 1
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Matich Corporation, rialto
Source Identification (SMARA, name of Pit or Job Site): 91-36-0040::LYTLE CREEK
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Conveyer Belt
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: LHP-62D
Lot number:
Sublot number:
Aggregate Mix Number:
DIME Test ID: 2021-08-11-7-1
Test Method: AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)
Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: prakash.gowda@dot.ca.gov
Organization Phone: (951) 232-3690
Data has not been verified.
DIME Test ID: 2021-08-11-7-2
Test Method: AASHTO T176-08: Standard Method of Test for Plastic Fines in Graded Aggregates and Soils by Use of the Sand Equivalent Test (Sand Equivalent)
Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: prakash.gowda@dot.ca.gov
Organization Phone: (951) 232-3690
Data has not been verified.
