Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993781 DEA: 07322404 EFIS: 0716000055
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-134-R12.6,R12.9
Work Description: REMOVE BRIDGE RAILING AND PLACE CONCRETE BARRIER.
Location Description: LOS ANGELES COUNTY IN PASADENA AT ARROYO SECO BRIDGE AND AT THE ORANGE GROVE BOULEVARD ON-RAMP OVERCROSSING
Contractor Name: BEADOR CONSTRUCTION
Contractor Address: 26320 LESTER CIRCLE, CORONA, CA 92883
Resident Engineer: Sam Toutounchian Structure Rep.: Ryan Vantine
DIME Sample ID: 2024-11-16-1
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: 11/16/2024
Date that the sample was received by the laboratory/organization performing the testing: 11/18/2024
The quantity of what the sample constitutes: 20 BX HMA 4 QT PG64-10 4 BGS CMB AGG 2 BG 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: 0634A-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA - CORONA
