Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002379 DEA: 113A9554 EFIS: 1125000172
QA Service Level: 1
DIST-CO-RTE-PM: 11---unknown
Work Description:
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2026-06-29-47
TL Number from the TL Form:
Sample Submitted By Organization: CT D11 - District 11 Materials Laboratory
Sample Organization Contact: (858) 518-8709
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 06/29/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/30/2026
The quantity of what the sample constitutes: 4 boxes
A brief description of the sample: Plant Sample
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Otay
