Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000802 DEA: 07346804 EFIS: 0718000079
QA Service Level: 1
DIST-CO-RTE-PM: 07-VEN-232-0.4/R4.1
Work Description: COLD PLANE AND OVERLAY WITH HMA & RHMA.
Location Description: VENTURA COUNTY IN AND NEAR OXNARD FROM ROUTE 232/101 SEPARATION TO ROUTE 118
Contractor Name: TORO ENTERPRISES, INC.
Contractor Address: Unknown
Resident Engineer: Pantaleon "Torch" Rivera Structure Rep.: Max Moheb
DIME Sample ID: 2026-07-22-81
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: 07/22/2026
Date that the sample was received by the laboratory/organization performing the testing: 07/20/2026
The quantity of what the sample constitutes: 4 Boxes of HMA
A brief description of the sample: 3/4" RWMA-G LAS 0.25%
From where was the sample collected: Manufacturer
Laboratory sample identification: 0535G-26
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan - Saticoy
Source Identification (SMARA, name of Pit or Job Site): 91-19-0020, 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 Plant
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number:
Lot number:
Sublot number:
Aggregate Mix Number:
