Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995085 DEA: 07322904 EFIS: 0716000059
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-27-0.0/18.6
Work Description: REMOVE EXISTING AC PAVEMENT & HMA OVERLAY.
Location Description: LOS ANGELES COUNTY IN AND NEAR LOS ANGELES FROM ROUTE 1 TO DEVONSHIRE STREET
Contractor Name: C. A. RASMUSSEN, INC.
Contractor Address: 28548 Livingston Ave, Valencia, CA 91355
Resident Engineer: Ravin Maru Structure Rep.: Unknown
DIME Sample ID: 2024-07-24-18
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: 07/24/2024
Date that the sample was received by the laboratory/organization performing the testing: 07/25/2024
The quantity of what the sample constitutes: 24 BOXES OF HMA, 4 BAGS OF COMBINED AGG, 2 BAGS OF COMBINED RAP, 4 QTS OF PG58-16, 1 QT OF EVO
A brief description of the sample: 1/2" WMA -A SP R25 .25% EVO
From where was the sample collected: Manufacturer
Laboratory sample identification: 0347A-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Sun Valley
