Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994583 DEA: 07333604 EFIS: 0716000313
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-2-2.3/14.2
Work Description: COLD PLANE AC, PLACE HMA, REPLACE CURB RAMPS AND TRAFFIC SIGNALS.
Location Description: LOS ANGELES COUNTY IN LOS ANGELES AT VARIOUS LOCATIONS FROM CENTINELA AVENUE TO GLENDALE BOULEVARD UNDERCROSSING
Contractor Name: SULLY-MILLER CONTRACTING COMPANY
Contractor Address: Unknown
Resident Engineer: Denrick Bautista Structure Rep.: Gon Choi
DIME Sample ID: 2025-11-03-23
TL Number from the TL Form:
Sample Submitted By Organization: Kleinfelder, Incorporated - Los Angeles
Sample Organization Contact: (909) 833-5780
Type of Sample: Quality Assurance
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: 67 CY
A brief description of the sample: CTM 231 Test Location
From where was the sample collected: Job Site
Laboratory sample identification: 25-3598
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Subgrade
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: CTM 231 test location
Where the material sample would have been placed if not sampled:
