Sample Record for 2023-11-02-46
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 993664 DEA: 073311U4 EFIS: 0719000098
QA Service Level: 1
DIST-CO-RTE-PM: 07-VEN-23,101-R3.3/R3.7,0.2/40.8
Work Description: CONSTRUCT GUARDRAILS AND CONCRETE BARRIER.
Location Description: VENTURA COUNTY IN THOUSAND OAKS, CAMARILLO, OXNARD AND VENTURA ON ROUTE 101 FROM THE LOS ANGELES /VENTURA COUNTY LINE TO OLD PACIFIC COAST HIGHWAY AND ON ROUTE 23 FROM ROUTE 23/101 SEPARATION TO HILLCREST DRIVE
Contractor Name: Peterson Chase General Engineering
Contractor Address: 16351 Construction Circle West, Irvine, CA 92606
Resident Engineer: Alfred Ira Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2023-11-02-46
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Verification
Type of Material: Aggregate
Sample Taken Date: 11/02/2023
Date that the sample was received by the laboratory/organization performing the testing: 11/07/2023
The quantity of what the sample constitutes: 2 bags of each bin (1,2,3,4) and 2 bags of sand and 1 bag of Rap
A brief description of the sample: 3/4" HMA-A-SP R15 0.50% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0570A-23
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Fish Canyon - Irwindale/ LTR/ ArrMaz
Material Information
Source Identification (SMARA, name of Pit or Job Site): 91-19-0035
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Vulcan Sun Valley
Where the material sample would have been placed if not sampled: Asphalt Paving
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: 220831 SVA LTR
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
