Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994415 DEA: 120R3114 EFIS: 1220000021
QA Service Level: 1
DIST-CO-RTE-PM: 12-LA,ORA-91-R20.6/R20.7,R0.0/4.8
Work Description: PLACE JPCP (RSC) AND RHMA, AND MODIFY ELECTRICAL SYSTEMS.
Location Description: LOS ANGELES AND ORANGE COUNTIES FROM 0.1 MILE WEST OF THE LOS ANGLES COUNTY LINE IN CERRITOS TO 0.1 MILE EAST OF ACACIA STREET UNDERCROSSING IN ANAHEIM
Contractor Name: BEADOR CONSTRUCTION COMPANY, INC.
Contractor Address: 2900 Bristol Street, Suite D204, Costa Mesa, CA 92626
Resident Engineer: Bill Gilchrist Structure Rep.: Mahesh Kapoor
DIME Sample ID: 2026-09-30-78
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: Asphalt Rubber Binder
Sample Taken Date: 09/30/2026
Date that the sample was received by the laboratory/organization performing the testing: 10/08/2026
The quantity of what the sample constitutes: 1can
A brief description of the sample: Asphalt Rubber Binder
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA-Irwindale
Asphalt modifier supplier:
Performance Grade: PG 64-16
Lot number:
Sublot number:
Asphalt Rubber Binder Mix Number:
