Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000669 DEA: 072XA704 EFIS: 0725000022
QA Service Level: 1
DIST-CO-RTE-PM: 07---unknown
Work Description:
Location Description:
Contractor Name: RJ Noble Company
Contractor Address: 15505 E. Lincoln Ave, Orange, CA 92865
Resident Engineer: Vanna Nguyen Structure Rep.: Unknown
DIME Sample ID: 2025-10-17-21
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: 10/17/2025
Date that the sample was received by the laboratory/organization performing the testing: 10/23/2025
The quantity of what the sample constitutes: 4 bags comb agg, 2 bags RAP
A brief description of the sample: PSUE 3/4" HMA A SP 25% RAP 0.25% EVO
From where was the sample collected: Manufacturer
Laboratory sample identification: 0661A-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: World Oil/ Ingevity/ Martin Marietta, Mayhew
Source Identification (SMARA, name of Pit or Job Site): 91-33-0014, 91-33-0035
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: Asphalt Paving
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: 36R2508SPWEO
Lot number:
Sublot number:
Aggregate Mix Number:
