Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993703 DEA: 070W0404 EFIS: 0721000028 MINOR: 11A3471
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-90-0.9/T3.3
Work Description: PCC GRINDING, SLAB REPLACEMENT, SLURRY SEAL & COLD PLANE AC PAVEMENT.
Location Description: LOS ANGELES COUNTY IN LOS ANGELES AND CULVER CITY FROM ROUTE 1 TO SLAUSON AVENUE
Contractor Name: AUTOBAHN CONSTRUCTION
Contractor Address: 933 N Batavia St,, Orange, CA 92867
Resident Engineer: Frank Shin Structure Rep.: Unknown
DIME Sample ID: 2023-05-15-31
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: 05/15/2023
Date that the sample was received by the laboratory/organization performing the testing: 05/17/2023
The quantity of what the sample constitutes: 1 Bag of Hi-Natural
A brief description of the sample: CRM Hi-Natural
From where was the sample collected: Manufacturer
Laboratory sample identification: 0260G-23
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan - Irwindale
DIME Test ID: 2023-05-15-31-1
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.
