Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000267 DEA: 070W6404 EFIS: 0722000357
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: 2024-11-12-28
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: 11/12/2024
Date that the sample was received by the laboratory/organization performing the testing: 11/13/2024
The quantity of what the sample constitutes: 4 bags comb Agg (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: 0616A-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: All American Asphalt- 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: Belt Cut at 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:
