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Sample Record for 2021-06-09-27

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

Project Information

Project ID: 214543 DEA: 080K8404 EFIS: 0800020563 QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-L5726-
Work Description: MAINTENANCE STATION BUILDING WORK.
Location Description: SAN BERNARDINO AT THE SAN BERNARDINO MAINTENANCE STATION AT 175 WEST CLUSTER STREET
Contractor Name: PCN3 Inc.
Contractor Address: 5450 Katella Ave. #101, Los Alamitos, CA, 90720
Resident Engineer: Nicholas Mineo Structure Rep.: Tim Flores

Sample Information

DIME Sample ID: 2021-06-09-27
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Sample Organization Contact: 9512323690
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 06/09/2021
Date that the sample was received by the laboratory/organization performing the testing: 06/16/2021
The quantity of what the sample constitutes: 2 Boxes
A brief description of the sample: HMA Type A SP R15 #324108
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Vulcan Corona

Material Information

HMA Type: Type A HMA
HMA Grading: 1/2 inch
Lot number:
Sublot number:
HMA Mix Number:
Test results on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2021-06-09-27-1
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: 06/28/2021
Date Tested: 06/16/2021
Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: prakash.gowda@dot.ca.gov
Organization Phone: (951) 232-3690
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
Bulk Specific Gravity 2.322
Bulk Specific Gravity 2 2.308
Average Bulk Specific Gravity 2.315

Test 2 of 2

DIME Test ID: 2021-06-09-27-2
Test Method: AASHTO T209-12: Standard Method of Test for Theoretical Maximum Specific Gravity (Gmm) and Density of Asphalt Mixtures (Maximum Specific Gravity)
Verified Date: 06/28/2021
Date Tested: 06/18/2021
Submitted By Organization: CT D08 - Fontana Field Testing Laboratory
Organization Address: 13970 Victoria Street,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: prakash.gowda@dot.ca.gov
Organization Phone: (951) 232-3690
General Comments for this Test:
Test Result Compliance: complies
Additional Comments When Verified:
Number of tests 1
What is the unit of measurement for theoretical density? US Units
Mass Determination Water
Specific Gravity for Sample 1 2.492
Theoretical maximum density at 25°C (77°F) no data