Sample Record for 2023-11-02-54
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 994821 DEA: 080J2404 EFIS: 0822000124
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-142-3.5/R3.9
Work Description: HMA (TYPE A), RUBBERIZED HMA (GAP GRADED), CL 2 AB, RDWY EXCAVATION.
Location Description: SAN BERNARDINO COUNTY IN CHINO HILLS FROM 0.5 MILE NORTH OF FELDSPAR DRIVE TO CHINO HILLS PARKWAY
Contractor Name: POWELL CONSTRUCTORS INC
Contractor Address: 644 Pedley Rd., Riverside. CA
Resident Engineer: Unknown Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2023-11-02-54
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: 11/02/2023
Date that the sample was received by the laboratory/organization performing the testing: 11/07/2023
The quantity of what the sample constitutes: 2 Bags of combined aggregate
A brief description of the sample: PSUE 3/4" RHMA-G-SP 0.5% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0569G-23
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA-Corona-SJR/ ROHM & HAAS-Morlife 5000
Material Information
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: Belt Cut at All American Asphalt Corona Plant
Where the material sample would have been placed if not sampled: Asphalt Paving
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: 106835
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
