Sample Record for 2026-03-21-10
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
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: Ridwan Salman Structure Rep.: Gon Choi
Sample Information
DIME Sample ID: 2026-03-21-10
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: 03/21/2026
Date that the sample was received by the laboratory/organization performing the testing: 03/25/2026
The quantity of what the sample constitutes: 4 bags coldfeed, 2 bags comb RAP
A brief description of the sample: PSUE 3/4" WMA-A-SP R25 0.50% EVO
From where was the sample collected: Manufacturer
Laboratory sample identification: 0161A-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Ingevity, Valero, Fish Canyon Irwindale, Vulcan Sun Valley
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-19-0035
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 Vulcan Sun Valley
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: 220200W SVA VLO
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
