Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215697 DEA: 07318204 EFIS: 0715000286
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-Route 1-4.0/4.2
Work Description: CM/GC Project - Work consists of constructing secant wall and slope restoration
Location Description: near Point Mugu State Park 0.4 mile South of Sycamore Canyon Road.
Contractor Name: Flatiron/Drill Tech, a Joint Venture
Contractor Address: 15335 Fairfield Ranch Rd, Chino Hills, CA 91709
Resident Engineer: Saeid Shakeri Structure Rep.: Azizollah Maghsoudloo
DIME Sample ID: 2024-04-15-20
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: 04/15/2024
Date that the sample was received by the laboratory/organization performing the testing: 04/16/2024
The quantity of what the sample constitutes: 16 BOXES OF HMA, 3BAGS OF AGG, 1 BAG OF RAP, 4 QTS OF BINDER
A brief description of the sample: 1/2" HMA-A-SP 15% RAP
From where was the sample collected: Manufacturer
Laboratory sample identification: 0178A-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: All American Asphalt-Irwindale
