Sample Record for 2023-11-15-3
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 993870 DEA: 120R5604 EFIS: 1218000117
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-5,55,73,91,133,405-var
Work Description: PLACE RHMA-G, HMA, SLAB REPLACEMENT AND JPCP.
Location Description: ORANGE COUNTY AT VARIOUS LOCATIONS
Contractor Name: SECURITY PAVING COMPANY INC.
Contractor Address: 3075 Towngate Road, St. 200, Westlake Village, CA 91361
Resident Engineer: Roy Rivera Structure Rep.: Vian Ghazi
Sample Information
DIME Sample ID: 2023-11-15-3
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: Soil
Sample Taken Date: 11/15/2023
Date that the sample was received by the laboratory/organization performing the testing: 11/15/2023
The quantity of what the sample constitutes: 3 Bags
A brief description of the sample: Structure Backfill
From where was the sample collected: Job Site
Laboratory sample identification: 23-0373
Structure unique identifier:
Structure name: STR 2
The fabricator/manufacturer/facility name: Native
Material Information
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: NB 405 SB 55 Conn RW STA 396 50
Where the material sample would have been placed if not sampled:
Test Results
