Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001065 DEA: 070Y1304 EFIS: 0724000134
QA Service Level: 1
DIST-CO-RTE-PM: 07-VEN-101-25.9/30.6
Work Description: MAINLINE INDIVIDUAL SLAB REPLACEMENT.
Location Description: VENTURA COUNTY IN VENTURA FROM 0.1 MILE WEST OF TELEPHONE RD UNDERCROSSING TO VENTURA AVENUE UNDERCROSSING
Contractor Name: RV CONCRETE, INC.
Contractor Address: 605 east commerce street, Anaheim CA 92801
Resident Engineer: Ranjit singh Structure Rep.: Unknown
DIME Sample ID: 2025-10-15-34
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: 10/15/2025
Date that the sample was received by the laboratory/organization performing the testing: 10/22/2025
The quantity of what the sample constitutes: 20 BX HMA 4 QT PG58-16 1 QT LAS 4 BG CMB AGG 2 BG RAP
A brief description of the sample: 3/4" HMA A SP R25 .50% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0656A-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: VULCAN - SATICOY
