Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000254 DEA: 070W6704 EFIS: 0723000018
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-103-0.0/1.7
Work Description: COLD PLANE AND OVERLAY, REPLACE ASPHALT CONCRETE SURFACING.
Location Description: LOS ANGELES COUNTY IN LOS ANGELES AND LONG BEACH FROM 0.1 MILE SOUTH OF UNION PACIFIC OVERHEAD TO 0.1 MILE NORTH OF ROUTE 1/103 SEPARATION
Contractor Name: CALMEX ENGINEERING, INC.
Contractor Address: Unknown
Resident Engineer: Ramon Robillos Structure Rep.: Unknown
DIME Sample ID: 2024-11-15-23
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: Hot Mix Asphalt
Sample Taken Date: 11/15/2024
Date that the sample was received by the laboratory/organization performing the testing: 11/19/2024
The quantity of what the sample constitutes: 14 BX HMA 4 QT PG64-10 3 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: 0635A-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA-Corona
