Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212112 DEA: 080C2514 EFIS: 0816000076 COOP: 081645
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-10-0.0/13.2
Work Description: Design-Build of I-10 Corridor Contract 1 - Adding 2 new Express Lanes
Location Description: LA/SBD County Line to PM 13.2 near I-15
Contractor Name: Lane-Security Paving Joint Venture
Contractor Address: 3450 Centre Lake Drive, 1st Floor, Ontario, CA 91761
Resident Engineer: Jose Corona Structure Rep.: Luis Negrete
DIME Sample ID: 2023-05-18-81
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Blythe Field Testing Laboratory
Sample Organization Contact: 9096015132
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 05/18/2023
Date that the sample was received by the laboratory/organization performing the testing: 05/22/2023
The quantity of what the sample constitutes: 1
A brief description of the sample: 3/4 hma core
From where was the sample collected: Job Site
Laboratory sample identification: LOT1 142-142A
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Las Vegs Paving Company-Las Vegas
DIME Test ID: 2023-05-18-81-1
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: 06/05/2023
Date Tested: 05/23/2023
Submitted By Organization: CT D08 - Blythe Field Testing Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: brian.teh@dot.ca.gov
Organization Phone: (909) 601-5132
General Comments for this Test: REL COMPACT 95.2%
Test Result Compliance: complies
Additional Comments When Verified:
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Bulk Specific Gravity
|
2.378
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