Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000253 DEA: 070W4504 EFIS: 0722000060
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-138-50.0/63.7
Work Description: PLACE HMA (TYPE A) AND COLD PLANE ASPHALT CONCRETE PAVEMENT.
Location Description: LOS ANGELES COUNTY IN AND NEAR PALMDALE FROM 0.1 MILE SOUTH OF AVENUE S TO 0.1 MILE EAST OF 165TH STREET EAST
Contractor Name: CALMEX ENGINEERING, INC.
Contractor Address: Unknown
Resident Engineer: Ramy Beshara Structure Rep.: Unknown
DIME Sample ID: 2024-08-21-52
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: Hot Mix Asphalt
Sample Taken Date: 08/21/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/23/2024
The quantity of what the sample constitutes: 24 BOX HMA 4 QT OIL 2 QT EVO 3 BAGS 3/8 3 BAGS WMF 2 BAGS RAP
A brief description of the sample: 3/8" WMA SP R20 .25% EVO
From where was the sample collected: Manufacturer
Laboratory sample identification: 0425A-24
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Palmdale
