Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215220 DEA: 07210624 EFIS: 0719000068
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA,SBD-71-1.8/R4.7&R0.0/R0.2
Work Description: PLACE STRUCTURE CONCRETE RETAINING WALLS & BOX CULVERT AND PLACE JPCP.
Location Description: IN LOS ANGELES AND SAN BERNARDINO COUNTIES IN POMONA AND CHINO HILLS FROM 0.2 MILE SOUTH OF MISSION BOULEVARD OVERCROSSING TO 0.2 MILE OF SAN BERNARDINO COUNTY LINE.
Contractor Name: OHL USA
Contractor Address: 1920 Main Street, Suite 310, Irvine, California 92614
Resident Engineer: Michael Wang Structure Rep.: Ryan Valentine
DIME Sample ID: 2025-10-16-44
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: 10/16/2025
Date that the sample was received by the laboratory/organization performing the testing: 10/22/2025
The quantity of what the sample constitutes: 20 BX RHMA 4 QT PG64-16 4 QT RBR BLND 1 QT LAS 4 BG CMB AGG 1 BG EA HN & CRM RBR
A brief description of the sample: 3/4" RHMA G SP .5% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0660G-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA Corona
