Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995057 DEA: 07321604 EFIS: 0716000049
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-1-0.0/18.0
Work Description: COLD PLANE AND OVERLAY AC PAVEMENT AND UPGRADE ADA CURB RAMPS.
Location Description: LOS ANGELES COUNTY FROM STUDEBAKER ROAD TO PASEO DE LAS DELICIAS
Contractor Name: R.J. NOBLE COMPANY
Contractor Address: 15505 E. Lincoln Ave, Orange, CA 92865
Resident Engineer: Thang Ton Structure Rep.: Unknown
DIME Sample ID: 2024-08-28-87
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: 08/28/2024
Date that the sample was received by the laboratory/organization performing the testing: 09/20/2024
The quantity of what the sample constitutes: 24 BX RHMMA 4 QT RB BLND 2 QT PG64-16 1 QT EVO 4 BGS CMB AG 2 BAGS CRUM 2 BAGS HN
A brief description of the sample: 1/2" RWMA G SP .25% EVO
From where was the sample collected: Manufacturer
Laboratory sample identification: 0489G-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RJ Noble-Corona
