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Sample Record for 2025-12-17-31

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 995468 DEA: 114B0084 EFIS: 1122000208 QA Service Level: 1
DIST-CO-RTE-PM: 11---
Work Description:
Location Description:
Contractor Name: Rubbia Khan Griffith COmpany
Contractor Address: 3050 East Birch Street, Brea, CA, 92821
Resident Engineer: Alfredo Hernandez Medina Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2025-12-17-31
TL Number from the TL Form:
Sample Submitted By Organization: CT D11 - District 11 Materials Laboratory
Sample Organization Contact: (858) 518-8709
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 12/17/2025
Date that the sample was received by the laboratory/organization performing the testing: 12/19/2025
The quantity of what the sample constitutes: 4 boxes
A brief description of the sample: Plant Sample
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Martin Marietta

Material Information

HMA Type: Type A HMA
HMA Grading: 1/2 inch
Lot number:
Sublot number:
HMA Mix Number: 21217105 MM
Binder content (%): 0.0
Virgin binder PG:
Design binder PG:
Binder Supplier:
RAP content (%):
WMA Additives:
Antistrip type:
Test results on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2025-12-17-31-1
Test Method: AASHTO T308-25: Standard Method of Test for Determining the Asphalt Binder Content of Hot Mix Asphalt (HMA) by the Ignition Method (Method A) (Asphalt Binder Content)
Submitted By Organization: CT D11 - District 11 Materials Laboratory
Organization Address: 4050 Taylor Street,
Organization City: San Diego
Organization State: CA
Organization Zipcode: 92110
Organization Email: benjamin.haney@dot.ca.gov
Organization Phone: (858) 688-1595
Data has not been verified.

Test 2 of 2

DIME Test ID: 2025-12-17-31-2
Test Method: AASHTO T209-22: Standard Method of Test for Theoretical Maximum Specific Gravity (Gmm) and Density of Asphalt Mixtures (Maximum Specific Gravity)
Submitted By Organization: CT D11 - District 11 Materials Laboratory
Organization Address: 4050 Taylor Street,
Organization City: San Diego
Organization State: CA
Organization Zipcode: 92110
Organization Email: benjamin.haney@dot.ca.gov
Organization Phone: (858) 688-1595
Data has not been verified.