Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000860 DEA: 072XL304 EFIS: 0724000159
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-10,5-14/17 & 35/36
Work Description: LA-010,: Secure the sites, clean-up and remove hazardous mat
Location Description:
Contractor Name: GRIFFITH COMPANY
Contractor Address: 12200 Bloomfield Ave, Santa Fe Springs
Resident Engineer: Sepand Minovi Structure Rep.: Unknown
DIME Sample ID: 2025-03-24-12
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: 03/24/2025
Date that the sample was received by the laboratory/organization performing the testing: 03/27/2025
The quantity of what the sample constitutes: 24 BX RHMA 4 BG CB AG 1 BG HN, 1 BG RBR CRM 2 QTS PG64-16 4 QTS RBR BLND 2 QTS LAS 1 QT EXT OIL
A brief description of the sample: 1/2" RHMA G SP .5% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0180G-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Irwindale
