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Sample Record for 2021-10-15-44

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

Project Information

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

Sample Information

DIME Sample ID: 2021-10-15-44
TL Number from the TL Form: na
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: 10/15/2021
Date that the sample was received by the laboratory/organization performing the testing: 11/24/2021
The quantity of what the sample constitutes: 750 Tons
A brief description of the sample: 3/4" hma-220831 sva sjr
From where was the sample collected: Job Site
Laboratory sample identification: 21-0443
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Materials Sun Valley

Material Information

HMA Type: Type A HMA
HMA Grading: 3/4 inch
Lot number: 1
Sublot number:
HMA Mix Number:
Test results on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2021-10-15-44-1
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 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.

Test 2 of 2

DIME Test ID: 2021-10-15-44-2
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 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.