Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000436 DEA: 051P1804 EFIS: 0521000181
QA Service Level: 1
DIST-CO-RTE-PM: 05-SCR-1-R5.0/8.2
Work Description: SHOULDERS WIDENING, ROADWAY EXCAVATION, HMA-A, AND RUMBLE STRIPS.
Location Description: SANTA CRUZ COUNTY FROM 0.9 MILE NORTH OF BUENA VISTA DRIVE UNDERCROSSING TO 0.2 MILE SOUTH OF ROB ROY JUNCTION OVERCROSSING
Contractor Name: GRANITE ROCK COMPANY
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2025-05-20-21
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Monterey Construction Field Laboratory
Sample Organization Contact: 831-818-0254
Type of Sample: Quality Assurance
Type of Material: Asphalt Binder
Sample Taken Date: 05/20/2025
Date that the sample was received by the laboratory/organization performing the testing: 05/21/2025
The quantity of what the sample constitutes: Production
A brief description of the sample: Used for HMA-A
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: San Joaquin Refinery, Bakersfield, CA
Performance Grade: PG 64-10
Modified: No
Lot number: 1
Sublot number: 5
Tank number:
Time of sample:
HMA Supplier: Graniterock Aromas Drum Plant
Certified Asphalt Supplier: San Joaquin Refinery - Bakersfield CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
