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: 2025-08-19-47
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: 08/19/2025
Date that the sample was received by the laboratory/organization performing the testing: 08/21/2025
The quantity of what the sample constitutes: 20 BX RHMA 4 QT PG64-16 4 QT RBR BLND 1 QT LAS 1 BG EA CRM RBR & HN 4 BGS CMB AGG
A brief description of the sample: 1/2" RHMA G SP 1.0% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0523G-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA Irwindale
