Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214523 DEA: 07302504 EFIS: 0713000479
QA Service Level: 1
DIST-CO-RTE-PM: 07-VEN-23-R3.3/R11.5
Work Description: PLACE HMA AND JPCP AND INDIVIDUAL SLAB REPLACEMENT.
Location Description: VENTURA COUNTY FROM ROUTE 101/23 SEPARATION TO NEW LOS ANGELES AVENUE UNDERCROSSING
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 3075 Townsgate Road, Suite 200, Westlake Village, CA 91361
Resident Engineer: Alan Davis Structure Rep.: Aziz Maghsoudloo
DIME Sample ID: 2021-11-19-12
TL Number from the TL Form: 111921A
Sample Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Sample Organization Contact: (213) 817-0387
Type of Sample: Department Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 11/19/2021
Date that the sample was received by the laboratory/organization performing the testing: 11/23/2021
The quantity of what the sample constitutes: 750 Tons
A brief description of the sample: 3/4-inch Type A HMA
From where was the sample collected: Source
Laboratory sample identification: 21-0437
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Sun Valley - Sheldon
DIME Test ID: 2021-11-19-12-1
Test Method: AASHTO T209-12: Standard Method of Test for Theoretical Maximum Specific Gravity (Gmm) and Density of Asphalt Mixtures (Maximum Specific Gravity)
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) 817-0387
Data has not been verified.
DIME Test ID: 2021-11-19-12-2
Test Method: AASHTO T308-10: 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 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) 817-0387
Data has not been verified.
DIME Test ID: 2021-11-19-12-3
Test Method: AASHTO T209-12: Standard Method of Test for Theoretical Maximum Specific Gravity (Gmm) and Density of Asphalt Mixtures (Maximum Specific Gravity)
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) 817-0387
Data has not been verified.
DIME Test ID: 2021-11-19-12-4
Test Method: AASHTO T308-10: 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 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) 817-0387
Data has not been verified.
