Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
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
DIME Sample ID: 2024-02-24-4
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: Production Start-Up
Type of Material: Hot Mix Asphalt
Sample Taken Date: 02/24/2024
Date that the sample was received by the laboratory/organization performing the testing: 03/04/2024
The quantity of what the sample constitutes: 18 BOXES OF RHMA-G, 4 BUCKETS OF AGG, 4 QTS OIL
A brief description of the sample: 3/4" RHMA-G-SP 0.5%LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0126G-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA-Corona
