Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995379 DEA: 072XF704 EFIS: 0723000127
QA Service Level: 1
DIST-CO-RTE-PM: 07-VEN-33-44.2/57.2
Work Description: Reconstruct slopes, place RSP, clean drainage systems
Location Description:
Contractor Name: R&R Demo and Grading
Contractor Address: 21777 VENTURA BLVD SUITE 245, WOODLAND HILLS, CA 91364
Resident Engineer: JOSEPH TEHRANI Structure Rep.: Unknown
DIME Sample ID: 2024-09-03-15
TL Number from the TL Form:
Sample Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Sample Organization Contact: (213) 817-0387
Type of Sample: Acceptance
Type of Material: Soil
Sample Taken Date: 09/03/2024
Date that the sample was received by the laboratory/organization performing the testing: 09/03/2024
The quantity of what the sample constitutes: 236 sy
A brief description of the sample: Ven-33 at postmile 42.94
From where was the sample collected: Job Site
Laboratory sample identification: 24-2691
Structure unique identifier:
Structure name: Ven-33 at postmile 42.94
The fabricator/manufacturer/facility name: R&R Demo
The fabricator's/manufacturer's product name for the sample: Embankment
The fabricator/manufacturer designation for the sample: various Embankment
A detailed description of where the material sample was collected: Jobsite
Where the material sample would have been placed if not sampled: Jobsite
