Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000669 DEA: 072XA704 EFIS: 0725000022
QA Service Level: 1
DIST-CO-RTE-PM: 07---
Work Description:
Location Description:
Contractor Name: RJ Noble Company
Contractor Address: 15505 E. Lincoln Ave, Orange, CA 92865
Resident Engineer: Vanna Nguyen Structure Rep.: Unknown
DIME Sample ID: 2025-07-12-3
TL Number from the TL Form:
Sample Submitted By Organization: CT D07 - Plant Services
Sample Organization Contact: 562-345-3126
Type of Sample: Acceptance
Type of Material: Aggregate
Sample Taken Date: 07/12/2025
Date that the sample was received by the laboratory/organization performing the testing: 07/16/2025
The quantity of what the sample constitutes: 700 tons
A brief description of the sample: 3/40HMA-A
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RJ Noble Orange
Source Identification (SMARA, name of Pit or Job Site): 91-33-0027
The fabricator's/manufacturer's product name for the sample: 3/4 HMA-A
The fabricator/manufacturer designation for the sample:
The plant number: Orange
A detailed description of where the material sample was collected: Belt Discharge
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: 36R2508SPWEO
Lot number:
Sublot number:
Aggregate Mix Number:
DIME Test ID: 2025-07-12-3-1
Test Method: AASHTO T27-14: Standard Method of Test for Sieve Analysis of Fine and Coarse Aggregates (Sieve Analysis)
Submitted By Organization: CT D07 - Plant Services
Organization Address: 13230 East Firestone Boulevard, Suite G,
Organization City: Santa Fe Springs
Organization State: CA
Organization Zipcode: 90670
Organization Email: victor.zengler@dot.ca.gov
Organization Phone: (562) 345-3126
Data has not been verified.
DIME Test ID: 2025-07-12-3-2
Test Method: AASHTO T11-5: Standard Method of Test for Materials Finer Than 75-μm (No. 200) Sieve in Mineral Aggregates by Washing
Submitted By Organization: CT D07 - Plant Services
Organization Address: 13230 East Firestone Boulevard, Suite G,
Organization City: Santa Fe Springs
Organization State: CA
Organization Zipcode: 90670
Organization Email: victor.zengler@dot.ca.gov
Organization Phone: (562) 345-3126
Data has not been verified.
DIME Test ID: 2025-07-12-3-3
Test Method: AASHTO T176-08: Standard Method of Test for Plastic Fines in Graded Aggregates and Soils by Use of the Sand Equivalent Test (Sand Equivalent)
Submitted By Organization: CT D07 - Plant Services
Organization Address: 13230 East Firestone Boulevard, Suite G,
Organization City: Santa Fe Springs
Organization State: CA
Organization Zipcode: 90670
Organization Email: victor.zengler@dot.ca.gov
Organization Phone: (562) 345-3126
Data has not been verified.
