Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993594 DEA: 120S9104 EFIS: 1221000060
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-57-11.0/22.2
Work Description: COLD PLANE AC PAVEMENT AND PLACE RHMA-G.
Location Description: ORANGE COUNTY AT VARIOUS LOCATIONS FROM 0.2 MILE SOUTH OF CHAPMAN AVENUE UNDERCROSSING TO 0.3 MILE SOUTH OF LOS ANGELES COUNTY LINE
Contractor Name: RJ Noble Company
Contractor Address: 15505 E. Lincoln Ave., Orange, CA 92865
Resident Engineer: Adrian Wu Structure Rep.: Unknown
DIME Sample ID: 2023-05-31-75
TL Number from the TL Form:
Sample Submitted By Organization: CT D12 - Huntington Beach Field Laboratory
Sample Organization Contact: 9492798846
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 05/31/2023
Date that the sample was received by the laboratory/organization performing the testing: 06/01/2023
The quantity of what the sample constitutes: HMA cores
A brief description of the sample: 1/2 RHMA-G
From where was the sample collected: Job Site
Laboratory sample identification: 23-0477
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RJ Noble Orange
DIME Test ID: 2023-05-31-75-1
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)
Verified Date: 06/23/2023
Date Tested: 06/16/2023
Submitted By Organization: CT D12 - Huntington Beach Field Laboratory
Organization Address: 19601 Beach Boulevard,
Organization City: Huntington Beach
Organization State: CA
Organization Zipcode: 92648
Organization Email: frank.mai@dot.ca.gov
Organization Phone: (949) 279-8846
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
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Bulk Specific Gravity
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2.278
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