Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001169 DEA: 07314524 EFIS: 0722000300 COOP: 075283
QA Service Level: 2
DIST-CO-RTE-PM: 07---
Work Description: I-105 METRO Express Lanes Project
Location Description: LA-105 PM R0.6/R10.1, LA-110 PM R14.1/R16.6
Contractor Name: Flatiron-Myers (JV)
Contractor Address: Unknown
Resident Engineer: Joahnna Vergara Structure Rep.: James Holloway
DIME Sample ID: 2026-07-09-131
TL Number from the TL Form:
Sample Submitted By Organization: Alta Vista Solutions - Whittier
Sample Organization Contact: (510) 542-9827
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 07/09/2026
Date that the sample was received by the laboratory/organization performing the testing: 08/21/2026
The quantity of what the sample constitutes: 81.17 Tons
A brief description of the sample: three quarter inch HMA Type A
From where was the sample collected: Job Site
Laboratory sample identification: 071326-ID1-HMA-1
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA Irwindale
