Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994966 DEA: 073255U4 EFIS: 0722000129
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-605-20.2/26
Work Description: INDIVIDUAL SLAB REPLACEMENT, COLD PLANE AC
Location Description: LOS ANGELES COUNTY IN BALDWIN PARK AND IRWINDALE FROM ROUTE 10/605 SEPARATION TO 0.2 MILE NORTH OF ROUTE 210/605 SEPARATION
Contractor Name: Peterson Chase General Engineering
Contractor Address: 16351 Construction Circle West, Irvine, CA 92606
Resident Engineer: Steven Taing Structure Rep.: Unknown
DIME Sample ID: 2025-06-17-92
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: 06/17/2025
Date that the sample was received by the laboratory/organization performing the testing: 06/24/2025
The quantity of what the sample constitutes: 22 BX HMA 1 QT PG64-10 2 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: 0386A-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA-Irwindale
