Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215360 DEA: 112N0454 EFIS: 1118000198
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-94-30.0/39.0
Work Description: PLACING CHIP SEAL, SLURRY SEAL, SHOULDER BACKING AND STRIPING.
Location Description: SAN DIEGO COUNTY NEAR DULZURA AND BARRETT JUNCTION FROM 0.9 MILE EAST OF GRANDE CREEK BRIDGE TO ROUTE 188.
Contractor Name: American Pavement Systems, Inc.
Contractor Address: 1012 11th Street, Suite 1000, Modesto, CA 95354
Resident Engineer: Benjamin Haney Structure Rep.: Unknown
DIME Sample ID: 2021-10-27-38
TL Number from the TL Form:
Sample Submitted By Organization: CT D11 - District 11 Materials Laboratory
Sample Organization Contact: (858) 688-1570
Type of Sample: Quality Control
Type of Material: Hot Mix Asphalt
Sample Taken Date: 10/27/2021
Date that the sample was received by the laboratory/organization performing the testing: 11/26/2021
The quantity of what the sample constitutes: 2 bags
A brief description of the sample: Aggregates
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: CCA
DIME Test ID: 2021-10-27-38-1
Test Method: CTM 302-April 2014: Method of Test for Stripping
Verified Date: 01/07/2022
Date Tested: 12/23/2021
Submitted By Organization: CT D11 - District 11 Materials Laboratory
Organization Address: 7177 Opportunity Road,
Organization City: San Diego
Organization State: CA
Organization Zipcode: 92111
Organization Email: dave.m.cortez@dot.ca.gov
Organization Phone: (858) 688-1570
General Comments for this Test: No Stripping
Test Result Compliance: complies
Additional Comments When Verified:
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Using
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Paving Grades of Asphalt
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