Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995119 DEA: 034H6004 EFIS: 0319000004
QA Service Level: 1
DIST-CO-RTE-PM: 03-PLA-49-R8.7/R10.6
Work Description: CONC BARRIER, JPCP, HMA, RDWY EXC, RCP AND LIGHTING.
Location Description: PLACER COUNTY NEAR AUBURN FROM 0.3 MILE SOUTH OF LORENSEN ROAD/FLORENCE LANE TO 0.4 MILE NORTH OF LONE STAR ROAD
Contractor Name: DESILVA GATES CONSTRUCTION, LLC
Contractor Address: Unknown
Resident Engineer: Jeff Johnson Structure Rep.: Asia Al Maliki
DIME Sample ID: 2025-05-19-70
TL Number from the TL Form:
Sample Submitted By Organization: Blackburn Consulting
Sample Organization Contact: (916) 375-8706
Type of Sample: Quality Assurance
Type of Material: Asphalt Binder
Sample Taken Date: 05/19/2025
Date that the sample was received by the laboratory/organization performing the testing: 05/20/2025
The quantity of what the sample constitutes: 1 Can
A brief description of the sample: PG 58-22
From where was the sample collected: Supplier
Laboratory sample identification: 5097
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: DeSilva Gates - Marysville
Performance Grade: PG 58-22
Modified: No
Lot number: 1
Sublot number: 1
Tank number: 2B
Time of sample:
HMA Supplier: DeSilva Gates Marysville
Certified Asphalt Supplier: Valero Marketing & Supply - Benicia CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
