Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993592 DEA: 120S8704 EFIS: 1221000056
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-55-0.2/T2.4
Work Description: COLD PLANE AC PAVEMENT AND PLACE RHMA-G.
Location Description: ORANGE COUNTY IN NEWPORT BEACH AND COSTA MESA FROM JUNCTION ROUTE 1 TO 0.4 MILE NORTH OF 19TH STREET
Contractor Name: CALMEX ENGINEERING INC.
Contractor Address: 2764 S VISTA AVE, BLOOMINGTON, CA 92316
Resident Engineer: Jay Joubeen Structure Rep.: Unknown
DIME Sample ID: 2022-09-12-60
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: 09/12/2022
Date that the sample was received by the laboratory/organization performing the testing: 09/12/2022
The quantity of what the sample constitutes: 16 Boxes RHMA-G, 3 Bags Aggregate, and 3 Quart Oil Can
A brief description of the sample: 1/2-inch RHMA-G
From where was the sample collected: Manufacturer
Laboratory sample identification: 22-0856
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Materials
