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: 2024-12-06-11
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: 12/06/2024
Date that the sample was received by the laboratory/organization performing the testing: 12/09/2024
The quantity of what the sample constitutes: 14 BX HMA 3 BG CMB AG 1 GB RAP 4 QT PG64-10 1 QT EVO
A brief description of the sample: 1/2" WMA A SP R15 .40% EVO
From where was the sample collected: Manufacturer
Laboratory sample identification: 0669A-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA - CORONA
