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: 2024-11-15-30
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: 11/15/2024
Date that the sample was received by the laboratory/organization performing the testing: 11/20/2024
The quantity of what the sample constitutes: 3 BAGS OF COMB AGG(1/2,3/8,, ROCK DUST,WCS), 1 BAGOF 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
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,CORONA QUARRR
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number: 104775-CORONA
Lot number:
Sublot number:
Aggregate Mix Number:
