Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995057 DEA: 07321604 EFIS: 0716000049
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-1-0.0/18.0
Work Description: COLD PLANE AND OVERLAY AC PAVEMENT AND UPGRADE ADA CURB RAMPS.
Location Description: LOS ANGELES COUNTY FROM STUDEBAKER ROAD TO PASEO DE LAS DELICIAS
Contractor Name: R.J. NOBLE COMPANY
Contractor Address: 15505 E. Lincoln Ave, Orange, CA 92865
Resident Engineer: Thang Ton Structure Rep.: Unknown
DIME Sample ID: 2025-06-05-18
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: 06/05/2025
Date that the sample was received by the laboratory/organization performing the testing: 06/06/2025
The quantity of what the sample constitutes: 20 BX HMA 4 QT PG58-22 1 QT EVO 4 BGS CMB AGG 2 BGS RAP
A brief description of the sample: 3/4" HMA A SP 25% RAP .25% EVO
From where was the sample collected: Manufacturer
Laboratory sample identification: 0340A-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RJ Noble Orange
