Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000891 DEA: 120U8104
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: 2025-08-01-51
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: 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: 1 Bag Of Crumb Rubber Scrap
A brief description of the sample: scrap
From where was the sample collected: Manufacturer
Laboratory sample identification: 0521G-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Belt cut at all America asphalt corona
