Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994121 DEA: 120P68U4 EFIS: 1218000105
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-1-13.0/33.7
Work Description: COLD PLANE, PLACE RHMA AND MODIFY CURB RAMPS AND ELECTRICAL SYSTEMS.
Location Description: ORANGE COUNTY AT VARIOUS LOCATIONS FROM CRYSTAL HEIGHTS DRIVE TO LOS ANGELES/ORANGE COUNTY LINE
Contractor Name: CHUMO CONSTRUCTION INC.
Contractor Address: 4949 2nd St., Fallbrook, CA 92028
Resident Engineer: Christopher Blanco Structure Rep.: Vian Ghazi
DIME Sample ID: 2025-02-06-21
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: Crumb Rubber Modifier
Sample Taken Date: 02/06/2025
Date that the sample was received by the laboratory/organization performing the testing: 02/12/2025
The quantity of what the sample constitutes: 1 Bag of Crumb Rubber Hi-Nat
A brief description of the sample: 1 Bag of CRM Hi-Nat
From where was the sample collected: Manufacturer
Laboratory sample identification: 0129G-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA - Corona/ SJR/ Ingevity
DIME Test ID: 2025-02-06-21-1
Test Method: CTM 385-July 2022: Method of Test for Crumb Rubber Modifier (CRM)
Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: (909) 829-3029
Data has not been verified.
