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: Vladimir Gurfinkel Structure Rep.: Unknown
DIME Sample ID: 2024-11-13-51
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: Aggregate
Sample Taken Date: 11/13/2024
Date that the sample was received by the laboratory/organization performing the testing: 11/15/2024
The quantity of what the sample constitutes: 4 Bags of Comb agg (1/2", 3/8", Rock dust, State Sand), 2 bags of RAP
A brief description of the sample: PSUE 1/2" WMA-A-SP R25 0.25% EVO
From where was the sample collected: Manufacturer
Laboratory sample identification: 0633A-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Fish Canyon Irwindale/ Vulcan Sun Valley/ Ingevity/ VLO
Source Identification (SMARA, name of Pit or Job Site): 91-19-0035, 91-19-0016
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Vulcan Sun Valley
Where the material sample would have been placed if not sampled: Asphalt Paving
Primary Aggregate Nominal Size: 3/8 inch
The concrete mix design number: 320200W SVA VLO
Lot number:
Sublot number:
Aggregate Mix Number: