Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214326 DEA: 07310404 EFIS: 0715000001
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-138-0.0/36.9
Work Description: PLACE HOT MIX ASPHALT AND COLD PLANE ASPHALT CONCRETE PAVEMENT. (EPD Pilot Project)
Location Description: LOS ANGELES COUNTY FROM ROUTE 5/138 SEPARATION TO ROUTE 138/14 SEPARATION
Contractor Name: CA Rasmussen Inc
Contractor Address: 28548 Livingston Ave, Valencia, CA 91355
Resident Engineer: Fred Tieu Structure Rep.: Unknown
DIME Sample ID: 2020-06-25-26
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: Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 06/25/2020
Date that the sample was received by the laboratory/organization performing the testing: 07/01/2020
The quantity of what the sample constitutes: 2536 Tons
A brief description of the sample: 3/4" HMA-A R25 PG64-16
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite-Littlerock
