Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001227 DEA: 074V5004 EFIS: 0723000160
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-210-R24.7/R25.3
Work Description: OVERLAY AC SHOULDER, REPLACE SHOULDER, AND SLAB REPLACEMENT.
Location Description: LOS ANGELES COUNTY IN PASADENA FROM 0.1 MILE EAST OF ORANGE GROVE BOULEVARD OVERCROSSING TO 0.2 MILE WEST OF MARENGO AVENUE OVERCROSSING
Contractor Name: CALMEX ENGINEERING, INC.
Contractor Address: 2750 South Lilac Avenue, Bloomington CA 92316
Resident Engineer: Ali Shalviri Structure Rep.: Unknown
DIME Sample ID: 2025-09-11-44
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: 09/11/2025
Date that the sample was received by the laboratory/organization performing the testing: 09/18/2025
The quantity of what the sample constitutes: 12 BX HMA, 6 BGS CMB AGG, 3 BGS RAP, 4 QTS PG64-10, 2 QTS EVO
A brief description of the sample: 3/4" WMA A SP R15 .4% EVO
From where was the sample collected: Manufacturer
Laboratory sample identification: 0592A-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA - CORONA
