Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993818 DEA: 07322504 EFIS: 0716000056
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-103-0.1/0.1
Work Description: UNION PACIFIC OH DECK REHABILITATION
Location Description: THE CITY AND COUNTY OF LOS ANGELES AT UNION PACIFIC OVERHEAD
Contractor Name: BEADOR CONSTRUCTION COMPANY, INC.
Contractor Address: 2900 Bristol Street, Suite D204, Costa Mesa, CA 92626
Resident Engineer: Thang Ton Structure Rep.: Sami Deeb
DIME Sample ID: 2025-06-12-67
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: 06/12/2025
Date that the sample was received by the laboratory/organization performing the testing: 06/18/2025
The quantity of what the sample constitutes: 20 BX HMA 5 QTS PG64-10 4 BGS CMB AGG 2 BGS RAP
A brief description of the sample: 3/4" HMA A SP R15 NO LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0372A-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA Irwindale
