Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214671 DEA: 07303904 EFIS: 0714000044
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-10-31.2/37.2
Work Description: LANE REPLACEMENT
Location Description: LOS ANGELES COUNTY IN BALDWIN PARK AND WEST COVINA FROM 0.1 MILE EAST OF THE 10/605 SEPARATION TO 0.3 MILE WEST OF CITRUS STREET OVERCROSSING
Contractor Name: Sierra Landscape Development Inc.
Contractor Address: 2209 1/2 Chico Ave., South El Monte CA, 91733
Resident Engineer: Hai Hong Structure Rep.: Unknown
DIME Sample ID: 2022-05-22-12
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: Department Acceptance
Type of Material: Rapid Set
Sample Taken Date: 05/22/2022
Date that the sample was received by the laboratory/organization performing the testing: 05/22/2022
The quantity of what the sample constitutes: 800 CY
A brief description of the sample: JPCPRS
From where was the sample collected: Other
Laboratory sample identification:
Structure unique identifier:
Structure name: WB 10 Lane 3 Between Azusa and Vincent
The fabricator/manufacturer/facility name: Security Paving batch plant
