Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994781 DEA: 07322704 EFIS: 0716000067
QA Service Level: 1
DIST-CO-RTE-PM: 07-VEN-1-1.3/26.6
Work Description: CONSTRUCT PERVIOUS CONCRETE PAVEMENT
Location Description: VENTURA COUNTY AT VARIOUS LOCATIONS
Contractor Name: AUTOBAHN CONSTRUCTION
Contractor Address: 933 North Batavia Street, Orange, CA 92867
Resident Engineer: Ranjit Singh Structure Rep.: Unknown
DIME Sample ID: 2025-05-07-53
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: 05/07/2025
Date that the sample was received by the laboratory/organization performing the testing: 05/07/2025
The quantity of what the sample constitutes: 24 BX RHMA 4 QT PG64-16 4 QT RBR BLND 2 QT LAS 1 QT EXT OIL 1 CN HN 1 CN CRM RBR 4 BG CMB AG
A brief description of the sample: 3/4" RHMA G SP .5% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0289G-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Sun Valley
