Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214708 DEA: 07323904 EFIS: 0716000072
QA Service Level: 1
DIST-CO-RTE-PM: 07-VEN-1-21.3/28.4
Work Description: COLD PLANE AC, PLACE RUBBERIZED HOT MIX AS
Location Description: VENTURA COUNTY NEAR VENTURA FROM ROUTE 1/101 SEPARATION TO MOBIL PIER ROAD.
Contractor Name: C. A. Rasmussen, Inc.
Contractor Address: 28548 Livingston Avenue, Valencia, CA 91355
Resident Engineer: Alfred Ira Structure Rep.: Unknown
DIME Sample ID: 2019-12-19-19
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: Preliminary
Type of Material: Soil
Sample Taken Date: 12/19/2019
Date that the sample was received by the laboratory/organization performing the testing: 12/20/2019
The quantity of what the sample constitutes: 1 bag
A brief description of the sample: SOIL SAMPLE OF SUBGRADE 2'-5' DEPTH
From where was the sample collected: Job Site
Laboratory sample identification: 9041
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Unknown
The fabricator's/manufacturer's product name for the sample: Unknown
The fabricator/manufacturer designation for the sample: Unknown
A detailed description of where the material sample was collected: PM 24.6 SB
Where the material sample would have been placed if not sampled: Unknown
DIME Test ID: 2019-12-19-19-1
Test Method: CTM 301-March 2000: Method for Determining the Resistance "R" Value of Treated and Untreated Bases, Subbases, and Basement Soils by the Stabilometer
Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: 9098293029
Data has not been verified.
