Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995193 DEA: 07356604 EFIS: 0719000026
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-605-R10.2/20.2
Work Description: LANE & SLAB REPLACEMENT, COLD PLANE & HMA OVERLAY.
Location Description: LOS ANGELES COUNTY IN SANTA FE SPRINGS, PICO RIVERA, WHITTIER, CITY OF INDUSTRY AND EL MONTE FROM TELEGRAPH ROAD UNDERCROSSING TO ROUTE 605/10 SEPARATION
Contractor Name: MYERS & SONS CONSTRUCTION, LLC
Contractor Address: 45 Morrison Ave, Sacramento, CA 95838
Resident Engineer: Jerome Arabe Structure Rep.: Tien Chu
DIME Sample ID: 2025-06-09-36
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: 06/09/2025
Date that the sample was received by the laboratory/organization performing the testing: 06/10/2025
The quantity of what the sample constitutes: 24 BX RHMA 1 QT PG64-16 1 QT RBR BLND 2 BGS CMB AGG 1 BG EA HN & CRM RBR
A brief description of the sample: 3/4" RHMA G SP .50% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0349G-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA - Irwindale
