Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995229 DEA: 07355404 EFIS: 0719000010
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-2,210-15.0/57.5,R18.7/R19.4
Work Description: REPLACE AND INSTALL DRAINAGE SYSTEM, AND PERFORM SLOPE PAVING.
Location Description: LOS ANGELES COUNTY ON ROUTE 2 FROM 1.0 MILE NORTH OF CLIFFORD STREET TO MOUNT WATERMAN SKI LIFTS AND ON ROUTE 210 FROM 0.5 MILE EAST OF OCEAN VIEW BOULVEARD OVERCROSSING TO 0.2 MILE EAST OF ALTA CANYADA ROAD OVERCROSSING
Contractor Name: CHUMO CONSTRUCTION INC.
Contractor Address: Unknown
Resident Engineer: Bill Tran Structure Rep.: Unknown
DIME Sample ID: 2024-10-09-17
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: Hot Mix Asphalt
Sample Taken Date: 10/09/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/10/2024
The quantity of what the sample constitutes: 16 BX HMA 4 QT PG64-16 1 QT EVO 2 BGS CMB AGG 1 BG CMB RAP
A brief description of the sample: 3/4" WMA A R15 .40% EVO
From where was the sample collected: Manufacturer
Laboratory sample identification: 0533A-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA-Irwindale
