Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993635 DEA: 120R7504 EFIS: 1219000030
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-5-R33.7/R35.4
Work Description: PLACE HMA, JPCP, INSTALL SIGN STRUCTURE, AND ELECTRICAL SYSTEMS.
Location Description: IN THE COUNTY OF ORANGE, IN THE CITIES OF ORANGE AND SANTA ANA, ON SB I-5 BETWEEN THE EB RTE 22/SB I-5 CONN AND NORTH OF STATE COLLEGE BLVD. UC
Contractor Name: PETERSON-CHASE GENERAL ENGINEERING CONSTRUCTION, INC.
Contractor Address: 16351 Construction Circle West, Irvine, CA 92606
Resident Engineer: Jessica Harvey Structure Rep.: Maheshwarlal Kapoor
DIME Sample ID: 2024-10-10-51
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: 10/10/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/18/2024
The quantity of what the sample constitutes: 21 BX HMA 3 QT PG64-10 2 BGS CMB AGG 2 BGS RAP
A brief description of the sample: 3/4" HMA A SP R15 NO LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0563A-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA-Corona
