Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 883101 DEA: 08TEST04 EFIS: 08TEST3101
QA Service Level: 1
DIST-CO-RTE-PM: 08---
Work Description: THIS PROJECT WAS ADDED FOR E3101 DEVELOPMENT AND TESTING PURPOSES. DATA SUBMITTED FOR THIS PROJECT MUST NOT BE USED FOR ANY OTHER PURPOSES.
Location Description: THIS PROJECT WAS ADDED FOR E3101 DEVELOPMENT AND TESTING PURPOSES. DATA SUBMITTED FOR THIS PROJECT MUST NOT BE USED FOR ANY OTHER PURPOSES.
Contractor Name: E3101 Test Prime 88
Contractor Address: Unknown
Resident Engineer: Julien Atallah Structure Rep.: Unknown
DIME Sample ID: 2026-04-29-5
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Sample Organization Contact: (858) 285-5797
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 04/29/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/29/2026
The quantity of what the sample constitutes: 250 tons
A brief description of the sample: 3/4 HMA-A
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA-Corona
