Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214698 DEA: 120N8904 EFIS: 1214000130
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-133-8.3/M9.3
Work Description: CONSTRUCT AUXILIARY LANE.
Location Description: ORANGE COUNTY IN IRVINE FROM ROUTE 133/405 SEPARATION TO IRVINE CENTER DRIVE OVERCROSSING
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 3200 Park Center Drive, Suite #200, Costa Mesa, CA 92626
Resident Engineer: Arezo Ghiam Structure Rep.: Melissa Quintana
DIME Sample ID: 2024-03-12-37
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: Production Start-Up
Type of Material: Hot Mix Asphalt
Sample Taken Date: 03/12/2024
Date that the sample was received by the laboratory/organization performing the testing: 03/21/2024
The quantity of what the sample constitutes: 19 BOXES OF HMA, 2 BAGS AGGS, 2 BAGS RAP, 3 QTS PG58-16
A brief description of the sample: 3/4" HMA-A-SP R25
From where was the sample collected: Manufacturer
Laboratory sample identification: 0147A-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: VULCAN CORONA DRUM
