Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993594 DEA: 120S9104 EFIS: 1221000060
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-57-11.0/22.2
Work Description: COLD PLANE AC PAVEMENT AND PLACE RHMA-G.
Location Description: ORANGE COUNTY AT VARIOUS LOCATIONS FROM 0.2 MILE SOUTH OF CHAPMAN AVENUE UNDERCROSSING TO 0.3 MILE SOUTH OF LOS ANGELES COUNTY LINE
Contractor Name: RJ Noble Company
Contractor Address: 15505 E. Lincoln Ave., Orange, CA 92865
Resident Engineer: Adrian Wu Structure Rep.: Unknown
DIME Sample ID: 2023-06-02-28
TL Number from the TL Form:
Sample Submitted By Organization: CT D12 - Huntington Beach Field Laboratory
Sample Organization Contact: 9492798846
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 06/02/2023
Date that the sample was received by the laboratory/organization performing the testing: 06/06/2023
The quantity of what the sample constitutes: 700 TONS
A brief description of the sample: RHMA-G
From where was the sample collected: Manufacturer
Laboratory sample identification: 23-0495
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: R.J.NOBLE-ORANGE
