Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994582 DEA: 073203U4 EFIS: 0722000071
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-91,605-R16.6/R16.8,R0.0/R10.4
Work Description: PLACE CONCRETE PAVEMENT AND HIGH FRICTION SURFACE TREATMENT.
Location Description: LOS ANGELES COUNTY ON ROUTE 605 FROM 0.2 MILE NORTH OF KATELLA AVENUE UNDECROSSING TO 0.1 MILE NORTH OF TELEGRAPH ROAD UNDERCROSSING AND ON ROUTE 91 FROM 0.4 MILE WEST OF ROUTE 605 UNDERCROSSING TO 0.2 MILE WEST OF ROUTE 605 UNDERCROSSING
Contractor Name: RASMUSSEN/VANGUARD
Contractor Address: 28548 LIVINGSTON AVENUE, VALENCIA CA 91335
Resident Engineer: Martin Oregel Structure Rep.: Tien Chu
DIME Sample ID: 2026-03-23-48
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: 03/23/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/03/2026
The quantity of what the sample constitutes: 4 bags Agg, 2 bags RAP
A brief description of the sample: JMF 3/4" HMA-A-SP 0.75% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0167A-26
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Irwindale, Fish Canyon Irwindale, Valero
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 at Vulcan Irwindale
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: 220992M IRW VLO
Lot number:
Sublot number:
Aggregate Mix Number:
