Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994582 DEA: 073203U4 EFIS: 0722000071
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-91,605-R16.6/R16.8,R0.0/R10.4
Work Description: PLACE CONCRETE PAVEMENT AND HIGH FRICTION SURFACE TREATMENT.
Location Description: LOS ANGELES COUNTY ON ROUTE 605 FROM 0.2 MILE NORTH OF KATELLA AVENUE UNDECROSSING TO 0.1 MILE NORTH OF TELEGRAPH ROAD UNDERCROSSING AND ON ROUTE 91 FROM 0.4 MILE WEST OF ROUTE 605 UNDERCROSSING TO 0.2 MILE WEST OF ROUTE 605 UNDERCROSSING
Contractor Name: RASMUSSEN/VANGUARD
Contractor Address: 28548 LIVINGSTON AVENUE, VALENCIA CA 91335
Resident Engineer: Martin Oregel Structure Rep.: Tien Chu
DIME Sample ID: 2024-06-17-68
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: 06/17/2024
Date that the sample was received by the laboratory/organization performing the testing: 06/20/2024
The quantity of what the sample constitutes: 24 BOX RHMA, 4 BAG AG, 1 BAG CRUM RB, 1 BAG HI NAT, 4 QT RUB BIND, 2 QT LAS, 1 QT EXT 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: 0299G-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Irwindale
