Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993631 DEA: 120S8904 EFIS: 1221000058
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-1-R0.1/R1.0
Work Description: COLD PLANE AC PAVEMENT AND PLACE RHMA.
Location Description: ORANGE COUNTY IN DANA POINT AND SAN JUAN CAPISTRANO FROM ROUTE 5/1 SEPARATION TO SAN JUAN CREEK BRIDGE
Contractor Name: RJ NOBLE
Contractor Address: Unknown
Resident Engineer: Irvin Nguyen Structure Rep.: Unknown
DIME Sample ID: 2023-05-18-41
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: 05/18/2023
Date that the sample was received by the laboratory/organization performing the testing: 05/22/2023
The quantity of what the sample constitutes: 100 TONS
A brief description of the sample: 3/4 HMA-A
From where was the sample collected: Manufacturer
Laboratory sample identification: 23-0439
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RJ NOBLE - ORANGE
