Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994772 DEA: 07385504 EFIS: 0722000147
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-91,110-Var
Work Description: PLACE ROCK BLANKETS, SLOPE PAVING, AND INSTALL FENCES AND GATES.
Location Description: LOS ANGELES COUNTY AT VARIOUS LOCATIONS
Contractor Name: WEST COAST PUBLIC WORKS, INC.
Contractor Address: 20058 VENTURA BLVD, #318, WOODLAND HILLS CA 91364
Resident Engineer: WAYNE LIU Structure Rep.: Unknown
DIME Sample ID: 2024-01-19-5
TL Number from the TL Form:
Sample Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Sample Organization Contact: (213) 817-0387
Type of Sample: Department Acceptance
Type of Material: Soil
Sample Taken Date: 01/19/2024
Date that the sample was received by the laboratory/organization performing the testing: 01/19/2024
The quantity of what the sample constitutes: 81 CY
A brief description of the sample: W Ave/1120 on ramp location#9
From where was the sample collected: Job Site
Laboratory sample identification: 24-0207
Structure unique identifier:
Structure name: W Ave/1120 on ramp location#9
The fabricator/manufacturer/facility name: West Coast
The fabricator's/manufacturer's product name for the sample: Subgrade
The fabricator/manufacturer designation for the sample: various location sugrade
A detailed description of where the material sample was collected: Jobsite
Where the material sample would have been placed if not sampled: Jobsite
