Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000267 DEA: 070W6404
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-2,134,170-Var
Work Description: METHACRYLATE, POLYESTER OVERLAY, SPILL REPAIR AND JOINT SEALS.
Location Description: LOS ANGELES COUNTY AT VARIOUS LOCATIONS
Contractor Name: TRUESDELL CORPORATION OF CALIFORNIA, INC.
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2024-11-12-5
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: 11/12/2024
Date that the sample was received by the laboratory/organization performing the testing: 11/12/2024
The quantity of what the sample constitutes: 13 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: 0616A-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA Irwindale
