Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993847 DEA: 081M8604 EFIS: 0822000056
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15-180.2/186.2
Work Description: COLD PLANE AC PAVEMENT AND PLACE RUBBERIZED HMA (GAP GRADED).
Location Description: SAN BERNARDINO COUNTY ABOUT 43 MILES NORTH OF BAKER FROM 0.5 MILE SOUTH OF YATES WELL ROAD OVERCROSSING TO NEVADA STATE LINE
Contractor Name: LAS VEGAS PAVING CORPORATIO
Contractor Address: 4420 SOUTH DECATUR BLV, LAS VEGAS NEVADA 8910
Resident Engineer: KHOA NGUYEN Structure Rep.: Unknown
DIME Sample ID: 2022-09-01-38
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: Hot Mix Asphalt
Sample Taken Date: 09/01/2022
Date that the sample was received by the laboratory/organization performing the testing: 09/12/2022
The quantity of what the sample constitutes: 2 boxes 200 tons out
A brief description of the sample: 3/4" HMA-A-SP R15 1.5%LSM
From where was the sample collected: Manufacturer
Laboratory sample identification: 0626A-22
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Las Vegs Paving Company-Las Vegas
