Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995361 DEA: 072XF604 EFIS: 0723000126
QA Service Level: 1
DIST-CO-RTE-PM: 07-VEN-33-24.25/27.3
Work Description: Rebuild the eroded side slopes, rebuild the damaged shoulders, reconstruct the dike, repair the sinkhole on the shoulder, repair the eroded areas next to EP, behind guardrail, and around the flumes, reinstall guardrail, rebuild RSP, clean the drainage systems, construct a SPW
Location Description:
Contractor Name: Granite Construction
Contractor Address: 4820 MCGRATH STE #101, VENTURA, CA 93003
Resident Engineer: Shamim Naderi Structure Rep.: Hussam Buran
DIME Sample ID: 2025-01-09-14
TL Number from the TL Form:
Sample Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Sample Organization Contact: (213) 817-0387
Type of Sample: Acceptance
Type of Material: Soil
Sample Taken Date: 01/09/2025
Date that the sample was received by the laboratory/organization performing the testing: 01/09/2025
The quantity of what the sample constitutes: 311 sy
A brief description of the sample: HWY 33 PM24.75
From where was the sample collected: Job Site
Laboratory sample identification: 25-0112
Structure unique identifier:
Structure name: HWY 33 PM24.75
The fabricator/manufacturer/facility name: Granite
The fabricator's/manufacturer's product name for the sample: Subgrade
The fabricator/manufacturer designation for the sample: various location sugrade
A detailed description of where the material sample was collected: Jobsite
Where the material sample would have been placed if not sampled: Jobsite
