Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214345 DEA: 120P94U4 EFIS: 1217000076
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-133-3.2/R4.1
Work Description: ROADWAY WIDENING, RESTRIPING AND DRAINAGE WORK.
Location Description: ORANGE COUNTY IN THE CITY OF LAGUNA BEACH FROM 0.2 MILE SOUTH OF EL TORO ROAD TO ROUTE 73/133 SEPARATION
Contractor Name: Granite Construction
Contractor Address: Unknown
Resident Engineer: Franklin Luna Structure Rep.: Chungkeun (Chung) Lee
DIME Sample ID: 2025-05-29-55
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: 05/29/2025
Date that the sample was received by the laboratory/organization performing the testing: 06/05/2025
The quantity of what the sample constitutes: 6 QTS PG64-10, 3 QTS EVO, 5 BGS CMB AGG
A brief description of the sample: 1/2" WMA - O
From where was the sample collected: Manufacturer
Laboratory sample identification: 0336O-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Corona
