Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 210735 DEA: 071193U4 EFIS: 0713000007
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-10-37.2/42.4
Work Description: CONSTRUCT HOV LANES, WIDEN BRIDGES, AND REALIGN RAMPS.
Location Description: IN LA COUNTY FROM CITRUS STREET IN WEST COVINA TO ROUTE 57 IN POMONA
Contractor Name: Guy F. Atkinson
Contractor Address: 18201 Von Karman Ave, Suite #800, IRVINE CA 92612
Resident Engineer: Rodolfo Cao Structure Rep.: David Win
DIME Sample ID: 2021-03-04-29
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: Quality Assurance
Type of Material: Soil
Sample Taken Date: 03/04/2021
Date that the sample was received by the laboratory/organization performing the testing: 03/05/2021
The quantity of what the sample constitutes: 12490 grams
A brief description of the sample: Native Material
From where was the sample collected: Job Site
Laboratory sample identification: 21-0716
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Collected at jobsite
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: I-10 EB to CA-57 Connector. East side of Kellog Drive Bridge.
Where the material sample would have been placed if not sampled:
DIME Test ID: 2021-03-04-29-1
Test Method: CTM 231-March 2013: Method of Test for Relative Compaction of Untreated and Treated Soils and Aggregates Using Nuclear Gages
Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Organization Address: 1940 South Workman Mill Road,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90601
Organization Email: chad.chotibhongs@dot.ca.gov
Organization Phone: (213) 817-0387
Data has not been verified.
DIME Test ID: 2021-03-04-29-2
Test Method: CTM 216-June 2011: Method of Test for Relative Compaction of Untreated and Treated Soils and Aggregates
Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Organization Address: 1940 South Workman Mill Road,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90601
Organization Email: chad.chotibhongs@dot.ca.gov
Organization Phone: (213) 817-0387
Data has not been verified.
