Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995233 DEA: 120U1804 EFIS: 1223000052
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-22,55-R3.3/R13.2,12.7/13.0
Work Description: COLD PLANE AND REPLACE EXISTING PAVEMENT WITH RHMA AND HMA.
Location Description: ORANGE COUNTY AT VARIOUS LOCATIONS
Contractor Name: R.J. NOBLE COMPANY
Contractor Address: 15505 East Lincoln Avenue, Orange, CA 92865
Resident Engineer: Mike Ezzedine Structure Rep.: Unknown
DIME Sample ID: 2024-04-12-29
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: Hot Mix Asphalt
Sample Taken Date: 04/12/2024
Date that the sample was received by the laboratory/organization performing the testing: 04/15/2024
The quantity of what the sample constitutes: 25 Boxes-Hot Mix Asphalt
A brief description of the sample: 3/4" WMA-A-SP 0.25% EVO
From where was the sample collected: Manufacturer
Laboratory sample identification: 0174A-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RJ Noble Orange
