Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000802 DEA: 07346804 EFIS: 0718000079
QA Service Level: 1
DIST-CO-RTE-PM: 07-VEN-232-0.4/R4.1
Work Description: COLD PLANE AND OVERLAY WITH HMA & RHMA.
Location Description: VENTURA COUNTY IN AND NEAR OXNARD FROM ROUTE 232/101 SEPARATION TO ROUTE 118
Contractor Name: TORO ENTERPRISES, INC.
Contractor Address: Unknown
Resident Engineer: Pantaleon "Torch" Rivera Structure Rep.: Unknown
DIME Sample ID: 2026-02-09-24
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: 02/09/2026
Date that the sample was received by the laboratory/organization performing the testing: 02/11/2026
The quantity of what the sample constitutes: 3 bags coldfeed agg, 2 bags RAP
A brief description of the sample: PSUE 3/4" HMA-A-SP R25 LAS 0.50%
From where was the sample collected: Manufacturer
Laboratory sample identification: 0132A-26
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Ingevity, Valero, Fish Canyon Irwindale, Vulcan Palmdale
Source Identification (SMARA, name of Pit or Job Site): 91-19-0035, 91-19-0020
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 Vulcan Saticoy
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: 220200 SAT VLO
Lot number:
Sublot number:
Aggregate Mix Number:
