Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001033 DEA: 070Y1404 EFIS: 0724000135
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-60-R23.0,R24.8
Work Description: MAINLINE SLABS, RAMPS, GORES, AUX LANES, SHOULDERS & DIGOUTS, SLURRY.
Location Description: LOS ANGELES COUNTY IN DIAMOND BAR FROM BREA CANYON ROAD UNDERCROSSING TO 0.4 MILE EAST OF GRAND AVENUE OVERCROSSING
Contractor Name: RV CONCRETE, INC.
Contractor Address: Unknown
Resident Engineer: Joe Doughly Structure Rep.: Unknown
DIME Sample ID: 2025-08-08-17
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: 08/08/2025
Date that the sample was received by the laboratory/organization performing the testing: 08/13/2025
The quantity of what the sample constitutes: 21 BOXES RHMA 3 QTS PG64-16 3 QTS RBR BLND 2 QTS EVO4 BGS CMB AGG 1 BG HN 1 BG CRM RBR
A brief description of the sample: 3/4" RHMA G SP .25% EVO
From where was the sample collected: Manufacturer
Laboratory sample identification: 0503G-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RJ Noble Orange
