Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993454 DEA: 040K8004 EFIS: 0416000141 COOP: 042892
QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN-101-13.7
Work Description: CONSTRUCT ROUNDABOUT, CURB RAMPS AND SW, SIGNAL AND LIGHTING SYSTEMS.
Location Description: MARIN COUNTY IN SAN RAFAEL AT FREITAS PARKWAY OVERCROSSING
Contractor Name: GHILOTTI BROS., INC.
Contractor Address: 525 JACOBY STREET, SAN RAFAEL CA 94901
Resident Engineer: Dawit Habteselassie Structure Rep.: Jeremy Light
DIME Sample ID: 2026-05-20-150
TL Number from the TL Form: C2026-05-20-02
Sample Submitted By Organization: CT D04 - Hayward DME / District Laboratory
Sample Organization Contact: (510) 507-3456
Type of Sample: Production Start-Up
Type of Material: Hot Mix Asphalt
Sample Taken Date: 05/20/2026
Date that the sample was received by the laboratory/organization performing the testing: 05/27/2026
The quantity of what the sample constitutes: 24 Boxes HMA
A brief description of the sample: 3/4" HMA-A + 15% RAP
From where was the sample collected: Manufacturer
Laboratory sample identification: D04-SE-26-014
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Dutra Richmond (DP)
DIME Test ID: 2026-05-20-150-1
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)
Submitted By Organization: CT D04 - Hayward DME / District Laboratory
Organization Address: 111 Grand Avenue,
Organization City: Oakland
Organization State: CA
Organization Zipcode: 94623
Organization Email: mohammad.dehghan@dot.ca.gov
Organization Phone: (510) 286-4717
Data has not been verified.
DIME Test ID: 2026-05-20-150-2
Test Method: AASHTO T269-24E25: Standard Method of Test for Percent Air Voids in Compacted Dense and Open Asphalt Mixtures (Air Void)
Submitted By Organization: CT D04 - Hayward DME / District Laboratory
Organization Address: 111 Grand Avenue,
Organization City: Oakland
Organization State: CA
Organization Zipcode: 94623
Organization Email: mohammad.dehghan@dot.ca.gov
Organization Phone: (510) 286-4717
Data has not been verified.
DIME Test ID: 2026-05-20-150-3
Test Method: AASHTO T283-14: Standard Method of Test for Resistance of Compacted Asphalt Mixtures to Moisture-Induced Damage (Moisture Content)
Submitted By Organization: CT D04 - Hayward DME / District Laboratory
Organization Address: 111 Grand Avenue,
Organization City: Oakland
Organization State: CA
Organization Zipcode: 94623
Organization Email: mohammad.dehghan@dot.ca.gov
Organization Phone: (510) 286-4717
Data has not been verified.
DIME Test ID: 2026-05-20-150-4
Test Method: CTM 389-19: Method of Test for Hamburg Wheel-Track Testing of Compacted Hot Mix Asphalt
Submitted By Organization: CT D04 - Hayward DME / District Laboratory
Organization Address: 111 Grand Avenue,
Organization City: Oakland
Organization State: CA
Organization Zipcode: 94623
Organization Email: mohammad.dehghan@dot.ca.gov
Organization Phone: (510) 286-4717
Data has not been verified.