Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002358 DEA: 070Y0104 EFIS: 0723000268
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-101-VAR
Work Description: RTE 101 BRIDGES - POLYESTER CONCRETE OVERLAY, METHACRYLATE DECK TREATMENT, JOINT SEALS, DECK REPAIR, AC CONFORM & PAVEMENT DELINEATION (21 BRIDGES, MISSION RD ONRAMP UC TO KANAN RD OC)
Location Description:
Contractor Name: J Franics Company
Contractor Address: 16194 Krameria Ave, Riverside, CA 92504
Resident Engineer: Denrick Bautista Structure Rep.: Unknown
DIME Sample ID: 2026-08-13-4
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: 08/13/2026
Date that the sample was received by the laboratory/organization performing the testing: 08/13/2026
The quantity of what the sample constitutes: 10 yd3
A brief description of the sample: Relative Compaction of Polymer Concrete
From where was the sample collected: Job Site
Laboratory sample identification: 26-2669
Structure unique identifier:
Structure name: Siver Lake Blvd UC
The fabricator/manufacturer/facility name: NA
DIME Test ID: 2026-08-13-4-1
Test Method: CTM 552-December 2013: Method of Test for Relative Compaction of Polymer Concrete Utilizing Nuclear Gages
Verified Date: 08/13/2026
Date Tested: 08/13/2026
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: NB US-101 - Lane #1
Test Result Compliance:
Additional Comments When Verified:
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Gage No.
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60293
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Time of test
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01:30 HH:MM
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Standard Density
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2.18 g/cc
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In-Place Density
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2.47 g/cc
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Percent Relative Compaction
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113 %
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