Sample Record for 2025-10-06-30
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1001225 DEA: 070Y1604 EFIS: 0724000137
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-210-R9.9/R22.5
Work Description: SLAB REPLACEMENT, SLURRY SEAL, AND DIGOUTS.
Location Description: LOS ANGELES COUNTY, IN LOS ANGELES, LA CANADA FLINTRIDGE, GLENDALE, AND PASADENA FROM BIG TUJUNGA WASH BRIDGE TO ARROYO BOULEVARD OVERCROSSING
Contractor Name: RV CONCRETE, INC.
Contractor Address: Unknown
Resident Engineer: Bill Tran Structure Rep.: Unknown
Sample Information
DIME Sample ID: 2025-10-06-30
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: 10/06/2025
Date that the sample was received by the laboratory/organization performing the testing: 10/09/2025
The quantity of what the sample constitutes: 5 bags of comb agg, 1 bag crumb rubber, 1 bag hi-nat
A brief description of the sample: PSUE 1/2" RHMA-G-SP 1.0% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0638G-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA-Corona/ Irwindale/ SJR/ Rohm & Haas (Morelife 5000)
Material Information
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: All American Asphalt Irwindale
Where the material sample would have been placed if not sampled: Asphalt Paving
Primary Aggregate Nominal Size: 1/2 inch
The concrete mix design number: 106836
Lot number:
Sublot number:
Aggregate Mix Number:
Test Results
