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: 2025-09-15-49
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: Aggregate
Sample Taken Date: 09/15/2025
Date that the sample was received by the laboratory/organization performing the testing: 09/22/2025
The quantity of what the sample constitutes: 4 Bags Combined Aggregate, 1 Bag Ea Crum Rubber & Hi-Nat
A brief description of the sample: PSU, 3/4" RHMA G SP .25% EVO
From where was the sample collected: Manufacturer
Laboratory sample identification: 0595G-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RJ Noble Orange Plant
Source Identification (SMARA, name of Pit or Job Site): 91-330035
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Belt Cut at RJ Noble Orange Plant
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: 49R003ARSPWEO
Lot number:
Sublot number:
Aggregate Mix Number:
