Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000266 DEA: 070W6304 EFIS: 0722000332
QA Service Level: 1
DIST-CO-RTE-PM: 07-VEN-33,101,118,126-Var
Work Description: METHACRYLATE, POLYESTER OVERLAY, AND SLOPE REPAIR.
Location Description: VENTURA COUNTY AT VARIOUS LOCATIONS
Contractor Name: TRUESDELL CORPORATION OF CALIFORNIA, INC.
Contractor Address: 1301 West 23rd Street, Tempe, AZ 85282
Resident Engineer: Joseph Tehrani Structure Rep.: Unknown
DIME Sample ID: 2024-09-14-4
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: Hot Mix Asphalt
Sample Taken Date: 09/14/2024
Date that the sample was received by the laboratory/organization performing the testing: 09/17/2024
The quantity of what the sample constitutes: 24 BOX HMA 4 QTS PG58-16 1 QT EVO 4 BAGS COMB AGG 2 BAGS RAP
A brief description of the sample: 3/8 WMA A SP R25 .25% EVO
From where was the sample collected: Manufacturer
Laboratory sample identification: 0480A-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: vulcan saticoy
