Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994620 DEA: 120T6304 EFIS: 1222000073
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-39-3.2/5.8
Work Description: COLD PLANE AC PVMT AND PLACE RHMA.
Location Description: ORANGE COUNTY IN HUNTINGTON BEACH FROM ELLIS AVENUE/MAIN STREET TO STARK DRIVE
Contractor Name: R.J. NOBLE COMPANY
Contractor Address: 15505 E. Lincoln Ave, Orange, CA 92865
Resident Engineer: Steven Kim Structure Rep.: Unknown
DIME Sample ID: 2023-09-08-25
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: 09/08/2023
Date that the sample was received by the laboratory/organization performing the testing: 09/13/2023
The quantity of what the sample constitutes: 1500 tons
A brief description of the sample: 3/4" HMA
From where was the sample collected: Manufacturer
Laboratory sample identification: 23-0919
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RJ.NOBLE-ORANGE
