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: 2024-11-16-6
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: Aggregate
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: 4 BAGS OF COMB AGG(3/4,1/2,3/8, ROCK DUST) 2 BAGS 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: All American Asphalt Corona
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: SJR/AAA-CORONA QUARRY
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 3/4 inch
The concrete mix design number: 105793
Lot number:
Sublot number:
Aggregate Mix Number:
