Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215518 DEA: 074W7704 EFIS: 0719000274
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-60-R0.6/R29.4
Work Description: METHATCRYLATE DECK, REPLACE JOINT SEAL, POLYESTER CONCRETE OVERLAY.
Location Description: LOS ANGELES COUNTY AT VARIOUS LOCATIONS FROM ROUTE 60/5 SEPARATION TO GAREY AVENUE UNDERCROSSING
Contractor Name: VELARDE CONCRETE CONSTRUCTION INC.
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2022-03-22-24
TL Number from the TL Form: na
Sample Submitted By Organization: CT D07 - Materials Field Laboratory, Unit 1953
Sample Organization Contact: (213) 817-0387
Type of Sample: Department Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 03/22/2022
Date that the sample was received by the laboratory/organization performing the testing: 04/27/2022
The quantity of what the sample constitutes: 750 Tons
A brief description of the sample: 3/4" hma - a220831 sva sjr
From where was the sample collected: Job Site
Laboratory sample identification: 22-0109
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA-Irwindale
DIME Test ID: 2022-03-22-24-1
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: 04/28/2022
Date Tested: 04/28/2022
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) 817-0387
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
Bulk Specific Gravity
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2.365
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