Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000286 DEA: 070W7004 EFIS: 0723000032
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-405-44.7/48.64
Work Description: INDIVIDUAL SLAB REPLACEMENT (RSC), & GRIND EXIST CONC PAVEMENT.
Location Description: LOS ANGELES COUNTY IN LOS ANGELES FROM NORDHOFF STREET UNDERCROSSING TO ROUTE 5/405 SEPARATION
Contractor Name: Interstate Civil Construction
Contractor Address: PO Box 2819, Wrightwood, CA 92397
Resident Engineer: ALI MOHSENZADEH Structure Rep.: Unknown
DIME Sample ID: 2025-03-24-73
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: Asphalt Rubber Binder
Sample Taken Date: 03/24/2025
Date that the sample was received by the laboratory/organization performing the testing: 04/03/2025
The quantity of what the sample constitutes: 1can
A brief description of the sample: Asphalt Rubber Binder
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Irwindale
Asphalt modifier supplier:
Performance Grade: PG 64-16
Lot number:
Sublot number:
Asphalt Rubber Binder Mix Number:
DIME Test ID: 2025-03-24-73-1
Test Method: ASTM D36-14ε1: Standard Test Method for Softening Point of Bitumen (Ring-and-Ball Apparatus) (Softening Point)
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.
DIME Test ID: 2025-03-24-73-2
Test Method: ASTM D217-21: Standard Test Methods for Cone Penetration of Lubricating Grease (Cone Penetration)
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.
DIME Test ID: 2025-03-24-73-3
Test Method: ASTM D5329-16: Standard Test Methods for Sealants and Fillers, Hot-Applied, for Joints and Cracks in Asphalt Pavements and Portland Cement Concrete Pavements (Asphalt Pavement)
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.
