Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214951 DEA: 120K0234 EFIS: 1214000100
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-5-17.1/18.9
Work Description: South County Improvement Project (Phase 3 - El Toro/Alicia) WIDEN FREEWAY AND BRIDGES, RECONSTRUCT BRIDGE AND WALLS.
Location Description: ORANGE COUNTY IN MISSION VIEJO, LAGUNA HILLS, LAGUNA WOODS AND LAKE FOREST FROM 0.4 MILE SOUTH OF ALICIA PARKWAY OVERCROSSING TO 0.2 MILE NORTH OF EL TORO ROAD UNDERCROSSING
Contractor Name: GUY F. ATKINSON CONSTRUCTION, LLC
Contractor Address: 18201 Von Karman Ave #800, Irvine, CA 92612
Resident Engineer: Irvin Nguyen Structure Rep.: Jason Kim
DIME Sample ID: 2022-11-04-14
TL Number from the TL Form:
Sample Submitted By Organization: CT D12 - Huntington Beach Field Laboratory
Sample Organization Contact: 9492798846
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 11/04/2022
Date that the sample was received by the laboratory/organization performing the testing: 11/04/2022
The quantity of what the sample constitutes: 200 tons out
A brief description of the sample: 3/4 RHMA-G
From where was the sample collected: Manufacturer
Laboratory sample identification: 22-1133
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: All American Asphalt Corona
