Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994781 DEA: 07322704 EFIS: 0716000067
QA Service Level: 1
DIST-CO-RTE-PM: 07-VEN-1-1.3/26.6
Work Description: CONSTRUCT PERVIOUS CONCRETE PAVEMENT
Location Description: VENTURA COUNTY AT VARIOUS LOCATIONS
Contractor Name: AUTOBAHN CONSTRUCTION
Contractor Address: 933 North Batavia Street, Orange, CA 92867
Resident Engineer: Ranjit Singh Structure Rep.: Unknown
DIME Sample ID: 2024-08-07-108
TL Number from the TL Form: 080724
Sample Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Sample Organization Contact: (213) 817-0387
Type of Sample: Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 08/07/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/29/2024
The quantity of what the sample constitutes: 750 tons
A brief description of the sample: 3/4" HMA-A cores 220200 SAT LTR
From where was the sample collected: Job Site
Laboratory sample identification: 24-209
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Materials Saticoy
