Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994968 DEA: 120M82C4 EFIS: 1219000036
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-1-7.9/10.5
Work Description: Place RHMA-G and minor concrete and modify electrical system.
Location Description: In Orange County In Laguna Beach, On State Route 1 (Also Known As Pacific Coast Highway Or Sr-1) From Ruby Street (Pm 7.9) To Ledroit
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Artin Merati Structure Rep.: Unknown
DIME Sample ID: 2024-09-24-47
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: 09/24/2024
Date that the sample was received by the laboratory/organization performing the testing: 09/26/2024
The quantity of what the sample constitutes: 18 BX RHMA 4 QT (PG64-16 RBR BND) 2 QTS (LAS ASP MOD) 4 BGS CMB AGG 1 BG (HI-NT CRM)
A brief description of the sample: 3/4" RHMA G SP .75% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0500G-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Blue Diamond- Irwindale
