Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215771 DEA: 09367504 EFIS: 0916000032
QA Service Level: 1
DIST-CO-RTE-PM: 09--5756-NA
Work Description: Building work, hot mix asphalt (type A)
Location Description: IN KERN COUNTY IN TEHACHAPI AT THE TEHACHAPI HIGHWAY MAINTENANCE STATION AT 305 INDUSTRIAL PARKWAY
Contractor Name: BOWE CONTRACTORS INC.
Contractor Address: 609 Bailey Ct, Tehachapi, CA 93561
Resident Engineer: Raj Bharathan Structure Rep.: Alex Naime
DIME Sample ID: 2024-04-18-14
TL Number from the TL Form:
Sample Submitted By Organization: CT D09 - Bishop Field Laboratory
Sample Organization Contact: (760) 872-5211
Type of Sample: Verification
Type of Material: Hot Mix Asphalt
Sample Taken Date: 04/18/2024
Date that the sample was received by the laboratory/organization performing the testing: 04/19/2024
The quantity of what the sample constitutes: 12 Boxes HMA-SP, JMF Verification
A brief description of the sample: 3/4" Type A HMA
From where was the sample collected: Source
Laboratory sample identification: JMF1 HMA1 1536112203
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Solari plant Granite Arvin
