Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994869 DEA: 073237U4 EFIS: 0720000224
QA Service Level: 1
DIST-CO-RTE-PM: 07-VEN-150-13.3/19
Work Description: PLACE HMA (TYPE A) AND COLD PLANE ASPHALT
Location Description: VENTURA COUNTY IN AND NEAR OJAI FROM BURNHAM ROAD TO GORHAM ROAD
Contractor Name: C. A. RASMUSSEN INC.
Contractor Address: 28548 Livingston Ave., Valencia, CA, 91355
Resident Engineer: Denrick Bautista Structure Rep.: Unknown
DIME Sample ID: 2024-10-07-54
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: Production Start-Up
Type of Material: Hot Mix Asphalt
Sample Taken Date: 10/07/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/14/2024
The quantity of what the sample constitutes: 20 BX HMA 4 QT PG64-10 1 QT LAS 4 BGS CMB AGG
A brief description of the sample: 3/4" HMA A SP .50% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0544A-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan - Saticoy
