Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000802 DEA: 07346804 EFIS: 0718000079
QA Service Level: 1
DIST-CO-RTE-PM: 07-VEN-232-0.4/R4.1
Work Description: COLD PLANE AND OVERLAY WITH HMA & RHMA.
Location Description: VENTURA COUNTY IN AND NEAR OXNARD FROM ROUTE 232/101 SEPARATION TO ROUTE 118
Contractor Name: TORO ENTERPRISES, INC.
Contractor Address: Unknown
Resident Engineer: Pantaleon "Torch" Rivera Structure Rep.: Unknown
DIME Sample ID: 2025-08-14-81
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: Crumb Rubber Modifier
Sample Taken Date: 08/14/2025
Date that the sample was received by the laboratory/organization performing the testing: 08/22/2025
The quantity of what the sample constitutes: 2 Qts of Hi-Nat
A brief description of the sample: 3/4" RWMA G SP .25% EVO
From where was the sample collected: Manufacturer
Laboratory sample identification: 0524G-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: BELT CUT AT VULCAN SATICOY
