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Sample Record for 2025-10-18-3

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Project Information

Project ID: 995228 DEA: 07347904 EFIS: 0718000123 QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-405-31.2/41.4
Work Description: COLD PLANE, PLACE HMA, RHMA, JPCP, ISR, & REPLACE BRIDGE SLABS.
Location Description: LOS ANGELES FROM WILSHIRE BOULEVARD UNDERCROSSING TO VICTORY BOULEVARD UNDERCROSSING
Contractor Name: RASMUSSEN/VANGUARD
Contractor Address: 28548 Livingston Ave, Valencia , CA,91355-4171
Resident Engineer: Denrick Bautista Structure Rep.: Gon Choi

Sample Information

DIME Sample ID: 2025-10-18-3
TL Number from the TL Form:
Sample Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Sample Organization Contact: (213) 817-0387
Type of Sample: Acceptance
Type of Material: Polyester
Sample Taken Date: 10/18/2025
Date that the sample was received by the laboratory/organization performing the testing: 10/18/2025
The quantity of what the sample constitutes: 50 CY
A brief description of the sample: POLYESTER CONCRTE COMPACTION TEST
From where was the sample collected: Job Site
Laboratory sample identification: 25-3363
Structure unique identifier: 53-0714
Structure name: Church Lane UC
The fabricator/manufacturer/facility name: Vanguard Construction

Material Information

Mfg. Lot Number(s): NA
Batch number: NA
Mix number: PPC 1121
Test results on following page(s): 1

Test Results

Test 1 of 1

DIME Test ID: 2025-10-18-3-1
Test Method: CTM 552-December 2013: Method of Test for Relative Compaction of Polymer Concrete Utilizing Nuclear Gages
Verified Date: 10/19/2025
Date Tested: 10/18/2025
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) 407-6963
General Comments for this Test: SB Rte. 405 @ Church Lane UC Concrete Expansion Dam
Test Result Compliance:
Additional Comments When Verified:
Gage No. 63090
Time of test 13:10 HH:MM
Standard Density 2160 g/cc
In-Place Density 2060 g/cc
Percent Relative Compaction 95 %