Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000888 DEA: 07346304 EFIS: 0718000073
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-101-7.9/11.8
Work Description: INSTALL RUBBERIZED HOT MIXED ASPHALT.
Location Description: LOS ANGELES COUNTY IN THE CITY AND COUNTY OF LOS ANGELES FROM 0.1 MILE SOUTH OF PILGRIMAGE OVERCROSSING TO ROUTE 101/170 SEPARATION.
Contractor Name: CHUMO CONSTRUCTION, INC.
Contractor Address: Unknown
Resident Engineer: Vladimir Gurfinkel Structure Rep.: Unknown
DIME Sample ID: 2026-08-18-75
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: 08/18/2026
Date that the sample was received by the laboratory/organization performing the testing: 08/24/2026
The quantity of what the sample constitutes: 6 Bags of Combined Aggregate, 1 Bag of Crum Rubber, 1 Bag of Hi-Nat
A brief description of the sample: 1/2" RHMA G SP 1.0% LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0539G-26
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: All American Asphalt-Irwindale
