Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212889 DEA: 073009U4 EFIS: 0714000238
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-110-R0.7/24.1
Work Description: REPLACE CONCRETE PAVEMENT, COLD PLANE AND PLACE HMA PAVEMENT.
Location Description: LOS ANGELES COUNTY IN AND NEAR LOS ANGELES AND CARSON FROM GAFFEY STREET TO 0.1 MILE SOUTH OF COLLEGE STREET OVERCROSSING
Contractor Name: All American Asphalt
Contractor Address: 400 E. 6th St., Corona, CA 92879
Resident Engineer: Thang Ton Structure Rep.: Quan Ho
DIME Sample ID: 2019-03-16-1
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: 03/16/2019
Date that the sample was received by the laboratory/organization performing the testing: 03/25/2019
The quantity of what the sample constitutes: 20 boxes
A brief description of the sample: HMA-A 3/4" R15 PG64-10
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA-Irwindale
