Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214819 DEA: 07288304 EFIS: 0700021024
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-60,60,164,210-Var
Work Description: STORM WATER MITIGATION
Location Description: LOS ANGELES COUNTY AT VARIOUS LOCATIONS
Contractor Name: CHUMO CONSTRUCTION INC
Contractor Address: 14425 Joanbridge St, Baldwin Park, CA 91706
Resident Engineer: Sushilkumar Chaudhari Structure Rep.: Pratheep Piratheepan
DIME Sample ID: 2021-11-10-19
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: Acceptance
Type of Material: Soil
Sample Taken Date: 11/10/2021
Date that the sample was received by the laboratory/organization performing the testing: 11/10/2021
The quantity of what the sample constitutes: 50 sq. yd.
A brief description of the sample: Structural Backfill
From where was the sample collected: Job Site
Laboratory sample identification: 21-2769
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Chumo Construction
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: Job site
Where the material sample would have been placed if not sampled:
DIME Test ID: 2021-11-10-19-1
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.
