Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000860 DEA: 072XL304 EFIS: 0724000159
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-10,5-14/17 & 35/36
Work Description: LA-010,: Secure the sites, clean-up and remove hazardous mat
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2024-12-18-23
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: Aggregate
Sample Taken Date: 12/18/2024
Date that the sample was received by the laboratory/organization performing the testing: 12/23/2024
The quantity of what the sample constitutes: 4 Bags of comb aggs(1/2,3/8, rock dust, state sand), 2 bags of comb rap
A brief description of the sample: 1/2" HMA-A-SP R25 0.7%LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0690A-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Irwindale
Source Identification (SMARA, name of Pit or Job Site): 91-19-0035
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: FISH CANYON-IRWINDALE/VULCAN-INWINDALE/MORLIFE/SJR
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number: 320200M IRW SJR
Lot number:
Sublot number:
Aggregate Mix Number:
