Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000286 DEA: 070W7004 EFIS: 0723000032
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-405-44.7/48.64
Work Description: INDIVIDUAL SLAB REPLACEMENT (RSC), & GRIND EXIST CONC PAVEMENT.
Location Description: LOS ANGELES COUNTY IN LOS ANGELES FROM NORDHOFF STREET UNDERCROSSING TO ROUTE 5/405 SEPARATION
Contractor Name: Interstate Civil Construction
Contractor Address: PO Box 2819, Wrightwood, CA 92397
Resident Engineer: ALI MOHSENZADEH Structure Rep.: Unknown
DIME Sample ID: 2025-03-26-68
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: Asphaltic Emulsion
Sample Taken Date: 03/26/2025
Date that the sample was received by the laboratory/organization performing the testing: 03/26/2025
The quantity of what the sample constitutes: 2qt, one container
A brief description of the sample: Emulsion- MSE
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Substanable Emuision
DIME Test ID: 2025-03-26-68-1
Test Method: AASHTO T59-22: Standard Method of Test for Emulsified Asphalts (Particle Charge Cationic Emulsified (Sec. 8))
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.
DIME Test ID: 2025-03-26-68-3
Test Method: AASHTO T59-18: Standard Method of Test for Emulsified Asphalts (Sieve Test (Sec. 13))
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.
