Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214469 DEA: 030H08U4 EFIS: 0319000029
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-50-L0.2/R6.1
Work Description: Sac 50 Design Build PLEASE NOTE THAT DESIGN BUILDER MUST PERFORM QUALITY VALIDATION TESTING IN ACCORDANCE WITH THE MATERIAL CONTROL SCHEDULE (MCS) FOR ITEMS SUCH AS STRANDS, HS BOLTS, ELASTOMERIC BEARING PADS, JOINT SEALANTS, COUPLERS & WELDED HOOPS, ETC
Location Description: FROM 0.1 MILE EAST OF I-5 TO 0.8 MILE EAST OF WATT AVE
Contractor Name: FLATIRON WEST INC
Contractor Address: 2100 Goodyear Rd., Benicia, CA 94510
Resident Engineer: John Ruzic Structure Rep.: Conor Hennessy
DIME Sample ID: 2023-03-08-90
TL Number from the TL Form:
Sample Submitted By Organization: CT D03 - Rocklin Construction Field Office
Sample Organization Contact: 530-330-2727
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 03/08/2023
Date that the sample was received by the laboratory/organization performing the testing: 03/09/2023
The quantity of what the sample constitutes: 750 Tons
A brief description of the sample: 3/4" HMA-A
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Perkins
DIME Test ID: 2023-03-08-90-1
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: 11/20/2025
Date Tested: 03/09/2023
Submitted By Organization: CT D03 - Rocklin Construction Field Office
Organization Address: 2520 Warren Drive, Suite A,
Organization City: Rocklin
Organization State: CA
Organization Zipcode: 95677
Organization Email: david.drane@dot.ca.gov
Organization Phone: (530) 330-2727
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
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Bulk Specific Gravity
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2.43
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DIME Test ID: 2023-03-08-90-2
Test Method: AASHTO T209-12: Standard Method of Test for Theoretical Maximum Specific Gravity (Gmm) and Density of Asphalt Mixtures (Maximum Specific Gravity)
Verified Date: 11/20/2025
Date Tested: 03/09/2023
Submitted By Organization: CT D03 - Rocklin Construction Field Office
Organization Address: 2520 Warren Drive, Suite A,
Organization City: Rocklin
Organization State: CA
Organization Zipcode: 95677
Organization Email: david.drane@dot.ca.gov
Organization Phone: (530) 330-2727
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
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Number of tests
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1
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What is the unit of measurement for theoretical density?
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SI Units
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Mass Determination
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Air
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Specific Gravity for Sample 1
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2.548
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Theoretical maximum density at 25°C (77°F)
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2548.4 kg/m^3
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DIME Test ID: 2023-03-08-90-3
Test Method: AASHTO T269-14: Standard Method of Test for Percent Air Voids in Compacted Dense and Open Asphalt Mixtures (Air Void)
Verified Date: 11/20/2025
Date Tested: 03/09/2023
Submitted By Organization: CT D03 - Rocklin Construction Field Office
Organization Address: 2520 Warren Drive, Suite A,
Organization City: Rocklin
Organization State: CA
Organization Zipcode: 95677
Organization Email: david.drane@dot.ca.gov
Organization Phone: (530) 330-2727
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
