Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994749 DEA: 120T6504 EFIS: 1222000075
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-57-11.5/18.6
Work Description: Cold plane AC Pavement and place RHMA.
Location Description: FOR CONSTRUCTION ON STATE HIGHWAY IN ORANGE COUNTY IN ORANGE, ANAHEIM, PLACENTIA, AND FULLERTON FROM 0.2 MILE SOUTH OF ORANGEWOOD AVENUE UNDERCROSSING TO 0.3 MILE NORTH OF YORBA LINDA BOULEVARD OVERCROSSING AT VARIOUS LOCATIONS
Contractor Name: RJ Noble Company
Contractor Address: 15505 E. Lincoln Ave, Orange, CA 92865
Resident Engineer: Mona Shahidi Structure Rep.: Unknown
DIME Sample ID: 2023-06-28-11
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: 06/28/2023
Date that the sample was received by the laboratory/organization performing the testing: 06/29/2023
The quantity of what the sample constitutes: 1000 TONS
A brief description of the sample: 1/2" RHMA-G
From where was the sample collected: Manufacturer
Laboratory sample identification: 23-0606
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RJ Noble - Orange
