Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000891 DEA: 120U8104 EFIS: 1224000036
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-57-11.0/22.5
Work Description: REMOVE AND REPLACE RHMA, PAVEMENT MARKING AND ROADSIDE SIGN.
Location Description: ORANGE COUNTY AT VARIOUS LOCATIONS FROM ROUTE 5/22/57 SEPARATION TO 0.3 MILE SOUTH OF LOS ANGELES COUNTY LINE
Contractor Name: AUTOBAHN CONSTRUCTION, INC.
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2025-08-01-49
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: Aggregate
Sample Taken Date: 08/01/2025
Date that the sample was received by the laboratory/organization performing the testing: 08/20/2025
The quantity of what the sample constitutes: 4 Bags comb agg,1 Bag each Hi- Nat and Crumb
A brief description of the sample: 1/2" RHMA-G-SP 1.0% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0521G-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: All American Asphalt Corona
Source Identification (SMARA, name of Pit or Job Site): 91-33-0005
The fabricator's/manufacturer's product name for the sample:
The fabricator/manufacturer designation for the sample:
The plant number:
A detailed description of where the material sample was collected: AAA Corona/SJR/ROHM HAAS
Where the material sample would have been placed if not sampled:
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number: 106836
Lot number:
Sublot number:
Aggregate Mix Number:
