Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994869 DEA: 073237U4 EFIS: 0720000224
QA Service Level: 1
DIST-CO-RTE-PM: 07-VEN-150-13.3/19
Work Description: PLACE HMA (TYPE A) AND COLD PLANE ASPHALT
Location Description: VENTURA COUNTY IN AND NEAR OJAI FROM BURNHAM ROAD TO GORHAM ROAD
Contractor Name: C. A. RASMUSSEN INC.
Contractor Address: 28548 Livingston Ave., Valencia, CA, 91355
Resident Engineer: Denrick Bautista Structure Rep.: Unknown
DIME Sample ID: 2024-09-24-112
TL Number from the TL Form: 665898
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: 09/24/2024
Date that the sample was received by the laboratory/organization performing the testing: 10/24/2024
The quantity of what the sample constitutes: 750 Tons
A brief description of the sample: 3/4" HMA-A CORES
From where was the sample collected: Job Site
Laboratory sample identification: 24-359
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Materials Saticoy
DIME Test ID: 2024-09-24-112-1
Test Method: AASHTO T275-07r12: Standard Method of Test for Bulk Specific Gravity (Gmb) of Compacted Asphalt Mixtures Using Paraffin-Coated Specimens (Bulk Specific Gravity)
Verified Date: 11/05/2024
Date Tested: 11/04/2024
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
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
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Bulk Specific Gravity
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2.311
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