Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001208 DEA: 022K6204 EFIS: 0225000120
QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-96-46.6/46.6
Work Description: Siskiyou 96 Potential Landslide DO Storm Damage
Location Description: IN SISKIYOU COUNTY NEAR HAPPY CAMP AT 2.3 MILES EAST OF GORDONS FERRY ROAD
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Nicholas Riddle Structure Rep.: Unknown
DIME Sample ID: 2025-04-17-48
TL Number from the TL Form: 823564
Sample Submitted By Organization: Atlas - Texas
Sample Organization Contact: 512-757-6352
Type of Sample: Quality Assurance
Type of Material: Asphalt Binder
Sample Taken Date: 04/17/2025
Date that the sample was received by the laboratory/organization performing the testing: 04/24/2025
The quantity of what the sample constitutes: 2 cans
A brief description of the sample: PG 58-22
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: JF Shea Fawndale
Performance Grade: PG 58-22
Modified: Yes
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: Valero Marketing & Supply - Benicia CA
Multigrade: Yes
Multigrade Type: PG 58-22 / PG 58-16
Asphalt Binder Mix Number:
