Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215221 DEA: 07332604 EFIS: 0716000287
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-10-R12.4/14.9
Work Description: REMOVE RAISED ISLAND, CONSTRUCT CONCRETE BARRIER AND INSTALL LIGHTING.
Location Description: THE COUNTY AND CITY OF LOS ANGELES FROM 0.1 MILE EAST OF ARLINGTON AVENUE OVERCROSSING TO 0.7 MILE EAST OF ROUTE 10/110 SEPARATION
Contractor Name: CHUMO CONSTRUCTION INC
Contractor Address: 14425 Joanbridge St, Baldwin Park, CA 91706
Resident Engineer: Gilbert Trujillo Structure Rep.: Bernabe Contreras
DIME Sample ID: 2021-11-02-12
TL Number from the TL Form: 923958A
Sample Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Sample Organization Contact: (213) 817-0387
Type of Sample: Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 11/02/2021
Date that the sample was received by the laboratory/organization performing the testing: 11/04/2021
The quantity of what the sample constitutes: 750 Tons
A brief description of the sample: 3/4" RHMA 106835
From where was the sample collected: Manufacturer
Laboratory sample identification: 21-0403
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA-Irwindale
DIME Test ID: 2021-11-02-12-2
Test Method: AASHTO T308-10: Standard Method of Test for Determining the Asphalt Binder Content of Hot Mix Asphalt (HMA) by the Ignition Method (Method A) (Asphalt Binder Content)
Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Organization Address: 1940 South Workman Mill Road,
Organization City: Whittier
Organization State: CA
Organization Zipcode: 90601
Organization Email: chad.chotibhongs@dot.ca.gov
Organization Phone: (213) 817-0387
Data has not been verified.
