Sample Record for 2024-11-25-13
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 993870 DEA: 120R5604 EFIS: 1218000117
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-5,55,73,91,133,405-var
Work Description: PLACE RHMA-G, HMA, SLAB REPLACEMENT AND JPCP.
Location Description: ORANGE COUNTY AT VARIOUS LOCATIONS
Contractor Name: SECURITY PAVING COMPANY INC.
Contractor Address: 3075 Towngate Road, St. 200, Westlake Village, CA 91361
Resident Engineer: Roy Rivera Structure Rep.: Vian Ghazi
Sample Information
DIME Sample ID: 2024-11-25-13
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: Aggregate
Sample Taken Date: 11/25/2024
Date that the sample was received by the laboratory/organization performing the testing: 12/03/2024
The quantity of what the sample constitutes: 3bags comb agg(3/4,1/2,3/8, rock dust
A brief description of the sample: 3/4'' RHMA-G-SP 0.5%
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: All American Asphalt Corona
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-33-0005
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Belt Cut at All American Asphalt Corona Plant
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: 106835
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
