Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214345 DEA: 120P94U4 EFIS: 1217000076
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-133-3.2/R4.1
Work Description: ROADWAY WIDENING, RESTRIPING AND DRAINAGE WORK.
Location Description: ORANGE COUNTY IN THE CITY OF LAGUNA BEACH FROM 0.2 MILE SOUTH OF EL TORO ROAD TO ROUTE 73/133 SEPARATION
Contractor Name: Granite Construction
Contractor Address: Unknown
Resident Engineer: Franklin Luna Structure Rep.: Chungkeun (Chung) Lee
DIME Sample ID: 2024-07-08-19
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: 07/08/2024
Date that the sample was received by the laboratory/organization performing the testing: 07/11/2024
The quantity of what the sample constitutes: 20 boxes of HMA, 4 qts of PG64-16, 4 bags of combined agg, 2 bags of RAP
A brief description of the sample: 3/4" HMA-A-SP-R15, .75 LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0320A-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Irwindale
