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: 2024-11-04-24
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: 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: 16 BX HMA 4 QT PG64-10 4 BG CMB AGG 1 BG RAP
A brief description of the sample: 1/2" HMA A SP R15 NO LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0604A-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA-Irwindale
