Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993562 DEA: 070Q7404 EFIS: 0720000271
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA--71-22/23
Work Description: IN LA COUNTY AT 710 & WASHINGTON BLVD. ON RAMPS AND OFF RAMPS RAMP WORK 0.2' COLD PLANE & 0.2' RHMA-G OVERLAY – CATEGORY OF 201.121 MINOR PAVEMENT REHAB (CAPM)
Location Description: Co-Rte-Post: LA-71-22/23
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2022-02-05-24
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: 02/05/2022
Date that the sample was received by the laboratory/organization performing the testing: 02/09/2022
The quantity of what the sample constitutes: 1 Bag of Hi-Natural
A brief description of the sample: Hi-Natural
From where was the sample collected: Manufacturer
Laboratory sample identification: 0125G-22
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: All American Asphalt-Irwindale
DIME Test ID: 2022-02-05-24-1
Test Method: CTM 385-November 2016: Method of Test for Crumb Rubber Modifier (CRM)
Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: (909) 829-3029
Data has not been verified.
