Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994065 DEA: 07329704 EFIS: 0716000204
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-170-R14.5/R16.6
Work Description: PLACE STAMPED CONCRETE, ROCK BLANKETS AND CONSTRUCT MVPS.
Location Description: LOS ANGELES COUNTY FROM ROUTE 170/134 SEPARATION TO OXNARD STREET UNDERCROSSING
Contractor Name: BOSCO CONSTRUCTORS INC.
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2023-06-06-39
TL Number from the TL Form:
Sample Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Sample Organization Contact: (213) 817-0387
Type of Sample: Department Acceptance
Type of Material: Soil
Sample Taken Date: 06/06/2023
Date that the sample was received by the laboratory/organization performing the testing: 06/06/2023
The quantity of what the sample constitutes: 114 yd2
A brief description of the sample: Soil for Subgrade.
From where was the sample collected: Job Site
Laboratory sample identification: 23-0806
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: N/A
The fabricator's/manufacturer's product name for the sample: Subgrade
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: From various locations at subgrade.
Where the material sample would have been placed if not sampled:
