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Sample Record for 2022-09-02-93

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 99999 DEA: 0322222 QA Service Level:
DIST-CO-RTE-PM: 03-SAC,OMG-888,99,80-0.6-0.6
Work Description: THIS PROJECT RECORD WAS ADDED FOR DIME TESTERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Location Description: THIS PROJECT RECORD WAS ADDED FOR DIME TESTERS - DATA SUBMITTED FOR THIS PROJECT SHOULD NOT BE USED FOR ANY OTHER PURPOSES.
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Michael Maksimovich Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2022-09-02-93
TL Number from the TL Form:
Sample Submitted By Organization: CT D02 - Mount Shasta Field Laboratory
Sample Organization Contact: (530) 605-5871
Type of Sample: Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 09/02/2022
Date that the sample was received by the laboratory/organization performing the testing: 09/02/2023
The quantity of what the sample constitutes: 250 Tons
A brief description of the sample: 3/4" HMA Type A
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: JF Shea Fawndale

Material Information

HMA Type: Type A HMA
HMA Grading: 3/4 inch
Lot number:
Sublot number:
HMA Mix Number:
Test results on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2022-09-02-93-1
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 D02 - Mount Shasta Field Laboratory
Organization Address: 1625 Mott Road,
Organization City: Mount Shasta
Organization State: CA
Organization Zipcode: 96067
Organization Email: nicole.mallory@dot.ca.gov
Organization Phone: (530) 605-5871
Data has not been verified.

Test 2 of 2

DIME Test ID: 2022-09-02-93-2
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 D02 - Mount Shasta Field Laboratory
Organization Address: 1625 Mott Road,
Organization City: Mount Shasta
Organization State: CA
Organization Zipcode: 96067
Organization Email: nicole.mallory@dot.ca.gov
Organization Phone: (530) 605-5871
Data has not been verified.