Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215302 DEA: 120M82A4 EFIS: 1219000036
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-1-7.9/10.5, 10.3/10.5
Work Description: A NEW PRIME CONTRACTOR HAS BEEN ASSIGNED. THE NEW CONTRACT NUMBER IS 12-0M82C4.
Location Description: ORANGE COUNTY IN LAGUNA BEACH FROM LEDROIT STREET TO RUBY STREET
Contractor Name: Beador Construction
Contractor Address: 16 Goodyear, Suite 140, Irvine, CA 92618
Resident Engineer: Jose Berrios Structure Rep.: Unknown
DIME Sample ID: 2023-02-17-24
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: 02/17/2023
Date that the sample was received by the laboratory/organization performing the testing: 02/17/2023
The quantity of what the sample constitutes: 16 boxes of 3/4 HMA-A, 4 bags of agg, 1 bag of RAP, 3 quartz of binder
A brief description of the sample: 3/4 HMA-A
From where was the sample collected: Manufacturer
Laboratory sample identification: 23-0143
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Blue Diamond Materials - Irwindale
