Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994310 DEA: 034F6504 EFIS: 0314000233
QA Service Level: 1
DIST-CO-RTE-PM: 03-YOL-50,80-0.0/2.5,4.1/R11.4
Work Description: CRCP, HMA (TYPE A), RDWY EXC, CLASS 2 AB, FIBER OPTIC CABLE SYSTEMS.
Location Description: YOLO COUNTY IN AND NEAR WEST SACRAMENTO ON ROUTE 80 FROM 1.7 MILES EAST OF MACE BOULEVARD OVERCROSSING TO SACRAMENTO RIVER BRIDGE AND OVERHEAD (BRYTE BEND) AND ON ROUTE 50 FROM ROUTE 80 JUNCTION TO JEFFERSON BOULEVARD UNDERCROSSING
Contractor Name: Flat-Iron Teichert A Joint Venture
Contractor Address: 1200 Concord Avenue Suite 465, Concord, CA 94520
Resident Engineer: Daniel Tecle Structure Rep.: Brent Bullard
DIME Sample ID: 2023-07-24-24
TL Number from the TL Form:
Sample Submitted By Organization: Blackburn Consulting
Sample Organization Contact: (916) 375-8706
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 07/24/2023
Date that the sample was received by the laboratory/organization performing the testing: 07/24/2023
The quantity of what the sample constitutes: 4 boxes
A brief description of the sample: 3/4" HMA SP 58-22
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Perkins
DIME Test ID: 2023-07-24-24-1
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: 08/09/2023
Date Tested: 07/24/2023
Submitted By Organization: Blackburn Consulting
Organization Address: 2491 Boatman Avenue,
Organization City: West Sacrametno
Organization State: CA
Organization Zipcode: 95691
Organization Email: brycem@blackburnconsulting.com
Organization Phone: (916) 375-8706
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
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Bulk Specific Gravity
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2.413
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