Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001617 DEA: 07360604 EFIS: 0719000275
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-101,210-Var
Work Description: REMOVE AND PLACE APPROACH SLABS, AND PLACE POLYESTER CONCRETE.
Location Description: LOS ANGELES COUNTY IN LOS ANGELES AT VARIOUS LOCATIONS
Contractor Name: TRUESDELL CORP OF CALIFORNIA INC
Contractor Address: 1310 W 23RD STREET, TEMPE AZ 85282
Resident Engineer: Nzhde Matevosyan Structure Rep.: Gon Choi
DIME Sample ID: 2026-04-01-12
TL Number from the TL Form:
Sample Submitted By Organization: CT SC - 3670 - Glendale
Sample Organization Contact: 2133170314
Type of Sample: Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 04/01/2026
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: multiple lanes
A brief description of the sample: Skid Testing Request
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Truesdell Corp.
Pavement Surface Type: Polyester Concrete
Type of Traffic Control Provided: Stationary Lane Closure
DIST-CO-RTE: D7-LA-101
Direction of Travel: South
Post Mile:
Lanes to be Tested: Off Ramp
Station: 7.053
