Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993153 DEA: 120H0474 EFIS: 1212000053
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-241-27.8/38.0
Work Description: PLACE HMA AND PERFORATED PLASTIC PIPE UNDERDRAIN.
Location Description: ORANGE COUNTY AT VARIOUS LOCATIONS FROM 0.1 MILE NORTH OF ROUTE 133 TO 0.5 MILE SOUTH OF ROUTE 91
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 3075 Townsgate Rd. Suite 200, Westlake Village CA 91361
Resident Engineer: Mohamad Yacoub Structure Rep.: Unknown
DIME Sample ID: 2022-09-20-44
TL Number from the TL Form:
Sample Submitted By Organization: CT D12 - Huntington Beach Field Laboratory
Sample Organization Contact: 9492798846
Type of Sample: Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 09/20/2022
Date that the sample was received by the laboratory/organization performing the testing: 09/20/2022
The quantity of what the sample constitutes: 16 boxes HMA-A, 2 bags Agg, 1 bag RAP, 2 Quart Oil
A brief description of the sample: 3/4 HMA-A
From where was the sample collected: Manufacturer
Laboratory sample identification: 22-0912
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Corona
