Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994688 DEA: 070W2904 EFIS: 0721000235
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-101-1.5/10.9
Work Description: DECK METHACRYLATE, JOINT SEAL REPLACEMENT, AC SURFACING, SPALL REPAIR.
Location Description: LOS ANGELES COUNTY IN LOS ANGELES AT VARIOUS LOCATIONS
Contractor Name: PETERSON-CHASE GENERAL ENGINEERING CONSTRUCTION INC.
Contractor Address: 16351 Construction Circle West, Irvine, CA, 92606
Resident Engineer: Jeanette Vong Structure Rep.: Unknown
DIME Sample ID: 2024-11-04-22
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: Aggregate
Sample Taken Date: 11/04/2024
Date that the sample was received by the laboratory/organization performing the testing: 11/07/2024
The quantity of what the sample constitutes: 4 bags comb aggs (1/2, 3/8", rock dust, wcs), 1 bag rap
A brief description of the sample: PSUE 1/2" HMA-A-SP 15% RAP NO LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0604A-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: All American- Corona/ SJR
Source Identification (SMARA, name of Pit or Job Site): 91-33-0005
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: All American - Irwindale
Where the material sample would have been placed if not sampled: Asphalt Paving
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number: 104775
Lot number:
Sublot number:
Aggregate Mix Number:
