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Testing Report for 2021-08-16-31-1

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

Project Information

DEA: 120S4504
EFIS: 1220000070
Project ID: 215446
QA Service Level: 1
DIST-CO-RTE-PM: 12-ORA-39-8.5/11.7
Work Description: COLD PLANE AC PVMT AND PLACE RHMA
Location Description: ORANGE COUNTY IN WESTMINSTER AND STANTON FROM ROUTE 22/39 SEPARATION TO STARR STREET
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Lieu Pham
Structure Rep.: Unknown

Sample Information

DIME Sample ID: 2021-08-16-31
TL Number from the TL Form:
Sample Submitted By Organization: CT - Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Verification
Type of Material: Crumb Rubber Modifier
Sample Taken Date: 8/16/2021
Date that the sample was received by the laboratory/organization performing the testing: 8/24/2021
The quantity of what the sample constitutes: 1 Bag of Hi-Natural Crumb Rubber
A brief description of the sample: Crumb Rubber High Natural
From where was the sample collected: Manufacturer
Laboratory sample identification: 0495G-21
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: RJ Noble Orange

Material Information

CRM Type: High Natural

Test Information

DIME Test ID: 2021-08-16-31-1
Test Method: CTM 385-November 2016: Method of Test for Crumb Rubber Modifier (CRM)
Date Tested: 8/25/2021
Verified Date: 9/3/2021
Submitted By Organization: CT - Southern Regional Laboratory
Organization Address: 13970 Victoria St,
Organization City: Fontana
Organization State: CA
Organization Zipcode: 92336
Organization Email: jose.guzman@dot.ca.gov
Organization Phone: 213-792-4794
General Comments for this Test: Actual % Fabric is 0.05
Test Result Compliance: complies
Additional Comments When Verified :

Submitted Test Results

Fabric in CRM: 0.10 %
Wire in CRM: 0.00 %