Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215365 DEA: 120Q9704 EFIS: 1218000010
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-405-0/11.4
Work Description: I-405 improvement project from I-5 to Harbor Boulevard including extend pavement life, improve safety, enhance traffic operation, and incorporate Intelligent Transportation Systems (ITS).
Location Description: Orange County I-405 PM 0 - 11.4
Contractor Name: Guy F. Atkinson
Contractor Address: 38 Executive Park, IRVINE CA 92614
Resident Engineer: Mona Shahidi Structure Rep.: Brian Vo
DIME Sample ID: 2025-06-23-32
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: 06/23/2025
Date that the sample was received by the laboratory/organization performing the testing: 06/27/2025
The quantity of what the sample constitutes: 24 BX RHMA 2 BG CMB AGG 2 QTS PG64-16 2 QTS RBR BLND
A brief description of the sample: 3/4" RHMA G SP 0.5% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0402G-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA Corona
