Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993387 DEA: 07323404 EFIS: 0716000064
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-5-R59.5/R67.9
Work Description: PLACE CULVERT, REPLACE DRAINAGE SYSTEM, RECONST ROADWAY & EMBANKMENT.
Location Description: LOS ANGELES COUNTY AT VARIOUS LOCATIONS FROM LAKE HUGHES ROAD UNDERCROSSING TO 1.9 MILES NORTH OF TEMPLIN HIGHWAY UNDERCROSSING
Contractor Name: SECURITY PAVING COMPANY INC
Contractor Address: 13170 TELEFAIR AVE, SYLMAR, CA 91342
Resident Engineer: Oscar Osorio Structure Rep.: Chanh Tong
DIME Sample ID: 2024-05-08-9
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: Asphalt Binder
Sample Taken Date: 05/08/2024
Date that the sample was received by the laboratory/organization performing the testing: 05/06/2024
The quantity of what the sample constitutes: 1can
A brief description of the sample: JMF verification sample
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan-Sun Valley
Performance Grade: PG 64-10
Modified:
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: San Joaquin Refinery - Bakersfield CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
