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: Ridwan Salman Structure Rep.: Gon Choi
DIME Sample ID: 2026-03-21-16
TL Number from the TL Form: 964776
Sample Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Sample Organization Contact: (213) 817-0387
Type of Sample: Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 03/21/2026
Date that the sample was received by the laboratory/organization performing the testing: 03/24/2026
The quantity of what the sample constitutes: 750 Tons
A brief description of the sample: 3/4" WMA-A
From where was the sample collected: Job Site
Laboratory sample identification: 26-061
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Materials Sun Valley
