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: 2022-07-30-7
TL Number from the TL Form:
Sample Submitted By Organization: Kleinfelder, Incorporated - Los Angeles
Sample Organization Contact: (909) 833-5780
Type of Sample: Quality Assurance
Type of Material: Soil
Sample Taken Date: 07/30/2022
Date that the sample was received by the laboratory/organization performing the testing: 07/30/2022
The quantity of what the sample constitutes: 18,000 SQ FT.
A brief description of the sample: Aggregate Base
From where was the sample collected: Job Site
Laboratory sample identification: 22-1956
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Aggregate Base
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: In-placed material
Where the material sample would have been placed if not sampled:
