Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993535 DEA: 081M1104 EFIS: 0821000078
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-215-10.0/17.2
Work Description: HMA, COLD PLANE AC PAVEMENT, AND TRAFFIC STRIPE TAPE.
Location Description: SAN BERNARDINO COUNTY?FROM 0.1 MILE NORTH OF 27TH STREET TO 0.1 MILE SOUTH OF DEVORE ROAD
Contractor Name: CALMEX ENGINEERING INC.
Contractor Address: 2764 S VISTA AVE, BLOOMINGTON, CA 92316
Resident Engineer: VuThanh Nguyen Structure Rep.: Unknown
DIME Sample ID: 2022-08-10-26
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: Hot Mix Asphalt
Sample Taken Date: 08/10/2022
Date that the sample was received by the laboratory/organization performing the testing: 08/17/2022
The quantity of what the sample constitutes: 2 Boxes HMA, 1 Qt PG64-28M 801.43 tons out
A brief description of the sample: 3/4" HMA-A-SP 0.5% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0557A-22
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan San Bernardino Portable
