Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995489 DEA: 07344204 EFIS: 0718000046
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-5,710-23.2/36.3,21.9
Work Description: CONSTRUCT GSRDS, MVPS, AND BIOSWALES.
Location Description: LOS ANGELES COUNTY AT VARIOUS LOCATIONS
Contractor Name: POWELL CONSTRUCTORS, INC.
Contractor Address: Unknown
Resident Engineer: Danglong Tran Structure Rep.: Gon Choi
DIME Sample ID: 2025-11-03-7
TL Number from the TL Form:
Sample Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Sample Organization Contact: (213) 817-0387
Type of Sample: Acceptance
Type of Material: Soil
Sample Taken Date: 11/03/2025
Date that the sample was received by the laboratory/organization performing the testing: 11/03/2025
The quantity of what the sample constitutes: 70 SF
A brief description of the sample: Structural Backfill
From where was the sample collected: Job Site
Laboratory sample identification: 25-3604
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: NA
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Jobsite
Where the material sample would have been placed if not sampled:
