Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994397 DEA: 073393U4 EFIS: 0722000031
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-605-R11.4/R19.5
Work Description: CONSTRUCT DPPIA DEVICES AND MODIFY LIGHTING SYSTEMS.
Location Description: LOS ANGELES COUNTY AT VARIOUS LOCATIONS FROM 0.1 MILE SOUTH OF SLAUSON AVENUE UNDERCROSSING TO 0.5 MILE NORTH OF VALLEY BOULEVARD UNDERCROSSING
Contractor Name: Chumo Construction
Contractor Address: 14425 Joanbridge St, Baldwin Park, CA 91706
Resident Engineer: Peter Lee Structure Rep.: Unknown
DIME Sample ID: 2024-06-04-77
TL Number from the TL Form: 060424
Sample Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Sample Organization Contact: (213) 817-0387
Type of Sample: Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 06/04/2024
Date that the sample was received by the laboratory/organization performing the testing: 06/11/2024
The quantity of what the sample constitutes: 750 Tons
A brief description of the sample: HMA Core
From where was the sample collected: Job Site
Laboratory sample identification: 24-123
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA Irwindale
DIME Test ID: 2024-06-04-77-1
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: 06/12/2024
Date Tested: 06/12/2024
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) 407-6963
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
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Bulk Specific Gravity
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2.328
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