Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995229 DEA: 07355404 EFIS: 0719000010
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-2,210-15.0/57.5,R18.7/R19.4
Work Description: REPLACE AND INSTALL DRAINAGE SYSTEM, AND PERFORM SLOPE PAVING.
Location Description: LOS ANGELES COUNTY ON ROUTE 2 FROM 1.0 MILE NORTH OF CLIFFORD STREET TO MOUNT WATERMAN SKI LIFTS AND ON ROUTE 210 FROM 0.5 MILE EAST OF OCEAN VIEW BOULVEARD OVERCROSSING TO 0.2 MILE EAST OF ALTA CANYADA ROAD OVERCROSSING
Contractor Name: CHUMO CONSTRUCTION INC.
Contractor Address: Unknown
Resident Engineer: Bill Tran Structure Rep.: Unknown
DIME Sample ID: 2025-03-28-27
TL Number from the TL Form:
Sample Submitted By Organization: Alta Vista Solutions - Whittier
Sample Organization Contact: (510) 542-9827
Type of Sample: Quality Assurance
Type of Material: Aggregate
Sample Taken Date: 03/28/2025
Date that the sample was received by the laboratory/organization performing the testing: 03/28/2025
The quantity of what the sample constitutes: 139 SY
A brief description of the sample: Subgrade
From where was the sample collected: Job Site
Laboratory sample identification: 25-0946
Structure unique identifier:
Structure name: SB -2 L18
The fabricator/manufacturer/facility name: N/A
Source Identification (SMARA, name of Pit or Job Site): N/A
The fabricator's/manufacturer's product name for the sample: Subgrade
The fabricator/manufacturer designation for the sample: Compaction testing
The plant number:
A detailed description of where the material sample was collected: Jobsite
Where the material sample would have been placed if not sampled: Jobsite
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
