Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995228 DEA: 07347904 EFIS: 0718000123
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-405-31.2/41.4
Work Description: COLD PLANE, PLACE HMA, RHMA, JPCP, ISR, & REPLACE BRIDGE SLABS.
Location Description: LOS ANGELES FROM WILSHIRE BOULEVARD UNDERCROSSING TO VICTORY BOULEVARD UNDERCROSSING
Contractor Name: RASMUSSEN/VANGUARD
Contractor Address: 28548 Livingston Ave, Valencia , CA,91355-4171
Resident Engineer: Denrick Bautista Structure Rep.: Gon Choi
DIME Sample ID: 2025-08-24-18
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: Production Start-Up
Type of Material: Hot Mix Asphalt
Sample Taken Date: 08/24/2025
Date that the sample was received by the laboratory/organization performing the testing: 08/27/2025
The quantity of what the sample constitutes: 15 BX HMA 8 QT RBR BLND 2 QT PG64-16 2 QT LAS 2 QT EXT OIL 6 BGS CMB AGG 2 BGS EA HN & CRM RBR
A brief description of the sample: 3/4" RHMA G SP .5% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0531G-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Sun Valley
