Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994621 DEA: 120T6404 EFIS: 1222000074
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-72-11.4/12.0
Work Description: PLACE RHMA-G AND MODIFY SIGNAL AND LIGHTING SYSTEM.
Location Description: ORANGE COUNTY IN LA HABRA FROM JUNCTION 39 AT WHITTIER-BEACH TO VALLEY HOME AVENUE
Contractor Name: CALMEX ENGINEERING INC.
Contractor Address: 2750 Lilac Ave, Bloomington, CA 92316
Resident Engineer: Mike Ezzedine Structure Rep.: Unknown
DIME Sample ID: 2023-09-13-25
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: 09/13/2023
Date that the sample was received by the laboratory/organization performing the testing: 09/14/2023
The quantity of what the sample constitutes: 1100 TONS
A brief description of the sample: 1/2" RHMA-G
From where was the sample collected: Manufacturer
Laboratory sample identification: 23-0949
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: VULCAN - IRWINDALE
