Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 209698 DEA: 072332E4 EFIS: 0700000391 COOP: 0705187
QA Service Level: 2
DIST-CO-RTE-PM: 07-LA-I-5-45.4/54
Work Description: Addition of 14 miles of HOV lanes in both directions would extend existing carpool lanes on the I- 5 in San Fernando Valley to Santa Clarita Valley
Location Description: The I-5 North Capacity Enhancements Project focuses on improvements to the I-5 freeway from cities of Santa Clarita and Castaic, beginning at the SR-14 interchange to Parker Rd.
Contractor Name: OHLA USA
Contractor Address: Unknown
Resident Engineer: James Shih Structure Rep.: Chanh Tong
DIME Sample ID: 2025-11-03-43
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: 11/03/2025
Date that the sample was received by the laboratory/organization performing the testing: 11/12/2025
The quantity of what the sample constitutes: 24 BOXES HMA 4 QT PG58--16 1 QT EVO 4 BG CMB AGG 2 BG RAP
A brief description of the sample: 3/4" HMA A SP R24 1.0% LSM
From where was the sample collected: Manufacturer
Laboratory sample identification: 0671A-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Fisher Sand and Gravel-Tempe
