Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994328 DEA: 081H0604 EFIS: 0816000130
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-74-34.3/45.1
Work Description: FIBER OPTIC CABLE SYSTEMS, RHMA, HMA, AND MINOR CONCRETE.
Location Description: RIVERSIDE COUNTY IN AND NEAR HEMET FROM WINCHESTER ROAD TO FAIRVIEW AVENUE
Contractor Name: GRIFFITH COMPANY
Contractor Address: Unknown
Resident Engineer: Omar Sanchez Structure Rep.: Arnel Vega
DIME Sample ID: 2023-11-06-49
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: Verification
Type of Material: Aggregate
Sample Taken Date: 11/06/2023
Date that the sample was received by the laboratory/organization performing the testing: 11/13/2023
The quantity of what the sample constitutes: 4 Bags of Combined Aggregate, 2 Bags of RAP
A brief description of the sample: 3/8" HMA-A-SP R15
From where was the sample collected: Manufacturer
Laboratory sample identification: 0572A-23
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA - Corona Quarry/ SJR
Source Identification (SMARA, name of Pit or Job Site): 91-33-0005
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: All American Asphalt Perris
Where the material sample would have been placed if not sampled: Asphalt Paving
Primary Aggregate Nominal Size: 3/8 inch
The concrete mix design number: 106926
Lot number:
Sublot number:
Aggregate Mix Number:
