Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994962 DEA: 07357304 EFIS: 0719000062
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-5-6.6/13.1
Work Description: REPLACE CONCRETE SLABS AND MEDIAN BARRIER,
Location Description: LOS ANGELES COUNTY IN SANTA FE SPRINGS, DOWNEY AND CITY OF COMMERCE FROM 0.2 MILE SOUTH OF ROUTE 5/605 SEPARATION TO 0.1 MILE NORT
Contractor Name: PETERSON-CHASE GENERAL ENGINEERING CONSTRUCTION, INC.
Contractor Address: 16351 Construction Circle West, Irvine, CA 92606
Resident Engineer: Martin Oregel Structure Rep.: Unknown
DIME Sample ID: 2025-07-22-33
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: Crumb Rubber Modifier
Sample Taken Date: 07/22/2025
Date that the sample was received by the laboratory/organization performing the testing: 07/24/2025
The quantity of what the sample constitutes: 1 Bag CRM RBR
A brief description of the sample: PSU RHMA-G-SP
From where was the sample collected: Manufacturer
Laboratory sample identification: 0458G-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA-Corona/ Irwindale/ SJR/ Rohm & HAAS (Morelife)
