Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995228 DEA: 07347904 EFIS: 0718000123
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-405-31.2/41.4
Work Description: COLD PLANE, PLACE HMA, RHMA, JPCP, ISR, & REPLACE BRIDGE SLABS.
Location Description: LOS ANGELES FROM WILSHIRE BOULEVARD UNDERCROSSING TO VICTORY BOULEVARD UNDERCROSSING
Contractor Name: RASMUSSEN/VANGUARD
Contractor Address: 28548 Livingston Ave, Valencia , CA,91355-4171
Resident Engineer: Denrick Bautista Structure Rep.: Gon Choi
DIME Sample ID: 2025-11-19-39
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: Hot Mix Asphalt
Sample Taken Date: 11/19/2025
Date that the sample was received by the laboratory/organization performing the testing: 11/24/2025
The quantity of what the sample constitutes: 23 BX HMA, 4 QT PG58-16, 2 QT EVO, 4 BGS CMB AGG, 2 BGS RAP
A brief description of the sample: 3/4" WMA A SP R25% EVO.50%
From where was the sample collected: Manufacturer
Laboratory sample identification: 0683A-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Irwindale
