Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993333 DEA: 04264724 EFIS: 0419000068
QA Service Level: 1
DIST-CO-RTE-PM: 04-MRN-101-R20.8/27.1
Work Description: CIP BRIDGES, CONSTRUCT ROADWAY, RETAINING WALLS AND MODIFY ELECTRICAL.
Location Description: MARIN COUNTY IN AND NEAR NOVATO FROM 0.1 MILE SOUTH OF FRANKLIN AVENUE OVERHEAD TO 0.5 MILE SOUTH OF SAN ANTONIO CREEK BRIDGE
Contractor Name: GHILOTTI CONSTRUCTION CO. INC. (RILEY GENAZZI & JOSH SERAFINO)
Contractor Address: 246 GHILOTTI AVE., SANTA ROSA, CA 95407
Resident Engineer: Fabio La Serna Structure Rep.: Jeremy Light
DIME Sample ID: 2022-11-05-25
TL Number from the TL Form: 867262
Sample Submitted By Organization: CT D04 - Petaluma Field Laboratory
Sample Organization Contact: (510) 385-6841
Type of Sample: Department Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 11/05/2022
Date that the sample was received by the laboratory/organization performing the testing: 11/08/2022
The quantity of what the sample constitutes: 2 bags
A brief description of the sample: 3/4"HMA with RAP
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Bodean Plant
DIME Test ID: 2022-11-05-25-1
Test Method: AASHTO T209-12: Standard Method of Test for Theoretical Maximum Specific Gravity (Gmm) and Density of Asphalt Mixtures (Maximum Specific Gravity)
Submitted By Organization: CT D04 - Petaluma Field Laboratory
Organization Address: 5675 Gibraltar Dr.,
Organization City: Pleasanton
Organization State: CA
Organization Zipcode: 94588
Organization Email: glenn.cea@dot.ca.gov
Organization Phone: (510) 385-6841
Data has not been verified.
