Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993870 DEA: 120R5604 EFIS: 1218000117
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-5,55,73,91,133,405-var
Work Description: PLACE RHMA-G, HMA, SLAB REPLACEMENT AND JPCP.
Location Description: ORANGE COUNTY AT VARIOUS LOCATIONS
Contractor Name: SECURITY PAVING COMPANY INC.
Contractor Address: 3075 Towngate Road, St. 200, Westlake Village, CA 91361
Resident Engineer: Roy Rivera Structure Rep.: Vian Ghazi
DIME Sample ID: 2025-04-21-64
TL Number from the TL Form:
Sample Submitted By Organization: CT D12 - Huntington Beach Field Laboratory
Sample Organization Contact: 9492798846
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 04/21/2025
Date that the sample was received by the laboratory/organization performing the testing: 04/21/2025
The quantity of what the sample constitutes: 3/4 RHMAG
A brief description of the sample: 3/4 RHMAG
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA Corona
DIME Test ID: 2025-04-21-64-1
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: 05/12/2025
Date Tested: 05/05/2025
Submitted By Organization: CT D12 - Huntington Beach Field Laboratory
Organization Address: 19601 Beach Boulevard,
Organization City: Huntington Beach
Organization State: CA
Organization Zipcode: 92648
Organization Email: frank.mai@dot.ca.gov
Organization Phone: (949) 279-8846
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
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Bulk Specific Gravity
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2.32
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