Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214524 DEA: 07304504 EFIS: 0714000067
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-57-R0.0/R4.5
Work Description: CONCRETE PAVEMENT, CONCRETE BARRIER, AND ELECTRICAL WORK.
Location Description: LOS ANGELES COUNTY IN DIAMOND BAR AND CITY OF INDUSTRY FROM ORANGE COUNTY LINE TO ROUTE 57/60 SEPARATION
Contractor Name: Griffith Company
Contractor Address: 3050 E. Birch Street, Brea, CA 92821
Resident Engineer: Martin Sandoval Structure Rep.: Avtar Bains
DIME Sample ID: 2022-01-06-48
TL Number from the TL Form: A0106C
Sample Submitted By Organization: CT D07 - Plant Services
Sample Organization Contact: 562-345-3126
Type of Sample: Department Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 01/06/2022
Date that the sample was received by the laboratory/organization performing the testing: 01/11/2022
The quantity of what the sample constitutes: 750 Tons
A brief description of the sample: 3/4" HMA-A 220831A IRW LTR
From where was the sample collected: Manufacturer
Laboratory sample identification: 22-0002
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Materials Irwindale
