Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994978 DEA: 09379504 EFIS: 0919000009
QA Service Level: 1
DIST-CO-RTE-PM: 09-INY-5709-
Work Description: CONSTRUCT BUILDING AND PLACE HMA.
Location Description: INYO COUNTY AT INDEPENDENCE AT THE INDEPENDENCE MAINTENANCE STATION AT 665 NORTH EDWARDS STREET
Contractor Name: FEC FUTURE CONTRACTORS AND ENGINEERS INC
Contractor Address: 184 Technology Drive, Irvine, CA 92618
Resident Engineer: George Elzawy Structure Rep.: Derek Armon
DIME Sample ID: 2025-07-08-25
TL Number from the TL Form: 4709
Sample Submitted By Organization: CT D09 - Bishop Field Laboratory
Sample Organization Contact: (760) 872-5211
Type of Sample: Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 07/08/2025
Date that the sample was received by the laboratory/organization performing the testing: 07/09/2025
The quantity of what the sample constitutes: 250 Tons
A brief description of the sample: 3/4" HMA Cores
From where was the sample collected: Job Site
Laboratory sample identification: CR-2
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RHB Plant Independence
DIME Test ID: 2025-07-08-25-1
Test Method: AASHTO T269-14: Standard Method of Test for Percent Air Voids in Compacted Dense and Open Asphalt Mixtures (Air Void)
Verified Date: 07/09/2025
Date Tested: 07/09/2025
Submitted By Organization: CT D09 - Bishop Field Laboratory
Organization Address: 500 South Main Street,
Organization City: Bishop
Organization State: CA
Organization Zipcode: 93514
Organization Email: chris.talbot@dot.ca.gov
Organization Phone: (760) 872-0794
General Comments for this Test: Density: CR-2A=92.5%
Test Result Compliance: complies
Additional Comments When Verified:
