Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214345 DEA: 120P94U4 EFIS: 1217000076
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-133-3.2/R4.1
Work Description: ROADWAY WIDENING, RESTRIPING AND DRAINAGE WORK.
Location Description: ORANGE COUNTY IN THE CITY OF LAGUNA BEACH FROM 0.2 MILE SOUTH OF EL TORO ROAD TO ROUTE 73/133 SEPARATION
Contractor Name: Granite Construction
Contractor Address: Unknown
Resident Engineer: Franklin Luna Structure Rep.: Chungkeun (Chung) Lee
DIME Sample ID: 2023-05-05-54
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Verification
Type of Material: Aggregate
Sample Taken Date: 05/05/2023
Date that the sample was received by the laboratory/organization performing the testing: 05/10/2023
The quantity of what the sample constitutes: 5 Bags of Aggregate
A brief description of the sample: JMF 1/2" WMA-O-SP
From where was the sample collected: Manufacturer
Laboratory sample identification: 0248O-23
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Materials Company - Corona
Source Identification (SMARA, name of Pit or Job Site): 91-33-0027
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: Manufacturer
Where the material sample would have been placed if not sampled: Asphalt Paving
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number: 320830 CORD SJR
Lot number:
Sublot number:
Aggregate Mix Number:
