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: 2023-05-08-15
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: 05/08/2023
Date that the sample was received by the laboratory/organization performing the testing: 05/09/2023
The quantity of what the sample constitutes: 600 TONS
A brief description of the sample: 3/4 HMA-A
From where was the sample collected: Manufacturer
Laboratory sample identification: 23-0387
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: VULCAN - CORONA
