Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994532 DEA: 010E8904 EFIS: 0115000043
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-101,299-88.3,0.0
Work Description: Arcata 101 Merge Improvements
Location Description: HUMBOLDT COUNTY IN ARCATA AT ROUTE 299/101 SEPARATION
Contractor Name: SHASTA SERVICES, INC. DBA TIMBERWORKS
Contractor Address: 509 S. Mt. Shasta Blvd., Mt. Shasta, CA 96067
Resident Engineer: Ryan Dunne Structure Rep.: Adlai Evans
DIME Sample ID: 2024-05-09-72
TL Number from the TL Form:
Sample Submitted By Organization: CT D01 - Crescent City Field Laboratory
Sample Organization Contact: (707) 496-5581
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 05/09/2024
Date that the sample was received by the laboratory/organization performing the testing: 05/09/2024
The quantity of what the sample constitutes: 3 CORE
A brief description of the sample: 1/2'" HMA-A CORE
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kernen Blue Lake Plant
DIME Test ID: 2024-05-09-72-1
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 D01 - Crescent City Field Laboratory
Organization Address: 1444 Parkway Dr.,
Organization City: Crescent City
Organization State: CA
Organization Zipcode: 95531
Organization Email: clayton.malmberg@dot.ca.gov
Organization Phone: (707) 496-5581
Data has not been verified.
