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: 2021-11-18-13
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Blythe Field Testing Laboratory
Sample Organization Contact: 9096015132
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 11/18/2021
Date that the sample was received by the laboratory/organization performing the testing: 11/22/2021
The quantity of what the sample constitutes: 2 boxes,3 cores
A brief description of the sample: 3/4" PG-64-16 #CHP-68-E
From where was the sample collected: Manufacturer
Laboratory sample identification: 28A, 28B, 28C
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Matich Corporation
DIME Test ID: 2021-11-18-13-1
Test Method: AASHTO T275-07r12: Standard Method of Test for Bulk Specific Gravity (Gmb) of Compacted Asphalt Mixtures Using Paraffin-Coated Specimens (Bulk Specific Gravity)
Submitted By Organization: CT D08 - Blythe Field Testing Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: brian.teh@dot.ca.gov
Organization Phone: (909) 601-5132
Data has not been verified.