Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214697 DEA: 07307104 EFIS: 0714000213
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-101-32.8
Work Description: CONSTRUCT BRIDGE.
Location Description: LOS ANGELES COUNTY IN AND NEAR AGOURA HILLS FROM 0.1 MILE WEST OF LIBERTY CANYON ROAD UNDERCROSSING TO 0.6 MILE EAST OF PALO COMADO OVERCROSSING
Contractor Name: CA Rasmussen
Contractor Address: 28548 LIVINGSTON AVENUE, VALENICA CA 91355
Resident Engineer: Sam Toutounchian Structure Rep.: Darwin Vargas
DIME Sample ID: 2024-02-12-9
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: 02/12/2024
Date that the sample was received by the laboratory/organization performing the testing: 02/12/2024
The quantity of what the sample constitutes: 100 sy
A brief description of the sample: Abutment 1: Btw temp shoring and Abutment 1 Footing
From where was the sample collected: Job Site
Laboratory sample identification: 24-0314
Structure unique identifier:
Structure name: Abutment 1: Btw temp shoring and Abutment 1 Footing
The fabricator/manufacturer/facility name: CA Rasmussen Inc.
The fabricator's/manufacturer's product name for the sample: Structural Backfill
The fabricator/manufacturer designation for the sample: from various locations at SBF
A detailed description of where the material sample was collected: Jobsite
Where the material sample would have been placed if not sampled: Jobsite
DIME Test ID: 2024-02-12-9-1
Test Method: CTM 231-March 2013: Method of Test for Relative Compaction of Untreated and Treated Soils and Aggregates Using Nuclear Gages
Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Organization Address: 1940 South Workman Mill Road,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90601
Organization Email: chad.chotibhongs@dot.ca.gov
Organization Phone: (213) 407-6963
Data has not been verified.
DIME Test ID: 2024-02-12-9-2
Test Method: CTM 216-June 2011: Method of Test for Relative Compaction of Untreated and Treated Soils and Aggregates
Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Organization Address: 1940 South Workman Mill Road,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90601
Organization Email: chad.chotibhongs@dot.ca.gov
Organization Phone: (213) 407-6963
Data has not been verified.
