Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001117 DEA: 033G4304 EFIS: 0324000127
QA Service Level: 1
DIST-CO-RTE-PM: 03-ED-89-0.0/8.5
Work Description: COLD PLANE AC PVMT AND HMA (TYPE A) OVERLAY.
Location Description: EL DORADO COUNTY NEAR MEYERS FROM ALPINE COUNTY LINE TO POMO STREET
Contractor Name: ALL-AMERICAN CONSTRUCTION, INC.
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2026-07-01-1
TL Number from the TL Form:
Sample Submitted By Organization: Blackburn Consulting
Sample Organization Contact: (916) 375-8706
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 07/01/2026
Date that the sample was received by the laboratory/organization performing the testing: 07/01/2026
The quantity of what the sample constitutes: 2 boxes 250 tons out
A brief description of the sample: 1/2"HMA-A-SP12%RAP
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Tahoe Asphalt
HMA Type: Type A HMA
HMA Grading: 1/2 inch
Lot number: 1
Sublot number: 13
HMA Mix Number: 2001
Binder content (%): 5.2
Virgin binder PG: PG 64-28
Design binder PG: PG 64-28
Binder Supplier: VSS Emultech
RAP content (%): 12
WMA Additives: No
Antistrip type:
DIME Test ID: 2026-07-01-1-1
Test Method: AASHTO T209-22: Standard Method of Test for Theoretical Maximum Specific Gravity (Gmm) and Density of Asphalt Mixtures (Maximum Specific Gravity)
Verified Date: 07/02/2026
Date Tested: 07/02/2026
Submitted By Organization: CT D03 - Olivehurst Northern Regional Laboratory
Organization Address: 5330 Arboga Road,
Organization City: Olivehurst
Organization State: CA
Organization Zipcode: 95961
Organization Email: jeff.herbert@dot.ca.gov
Organization Phone: (530) 741-4238
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
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Number of Samples
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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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Method Performed
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Mechanical Agitation - Method A
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Mass of container filled with water 1
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7402.5 grams
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Mass of oven-dry sample in air for Sample 1
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2610.8 grams
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Mass of container filled with the sample and water for Sample 1
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8996.2 grams
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Temperature of Water
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25 °F
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Specific Gravity for Sample 1
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2.567
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Theoretical maximum density at 25°C (77°F)
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2560 kg/m^3
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