Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994859 DEA: 021H5904 EFIS: 0216000025
QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-96-43.5,57.0
Work Description: REPLACE CULVERTS WITH BRIDGES, STREAMBED RESTORATION, & LANDSCAPING.
Location Description: SISKIYOU COUNTY AT AND NEAR HAPPY CAMP AT 0.8 MILE WEST OF GORDON\\\\'S FERRY ROAD AND AT PORTUGUESE CREEK
Contractor Name: J.F. SHEA CONSTRUCTION, INC.
Contractor Address: 17400 CLEAR CREEK ROAD, REDDING, CA 96001
Resident Engineer: Nicholas Riddle Structure Rep.: Nicolas Jimenez
DIME Sample ID: 2025-05-21-74
TL Number from the TL Form: 867339
Sample Submitted By Organization: Atlas - Denver
Sample Organization Contact: 303-975-9959
Type of Sample: Quality Assurance
Type of Material: Asphalt Binder
Sample Taken Date: 05/21/2025
Date that the sample was received by the laboratory/organization performing the testing: 06/02/2025
The quantity of what the sample constitutes: 1 can
A brief description of the sample: PG 64-28 M
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Mercer Fraser Willow Creek
Performance Grade: PG 64-28 M
Modified: Yes
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: Valero Marketing & Supply - Benicia CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
DIME Test ID: 2025-05-21-74-9
Test Method: AASHTO T315-24: Standard Method of Test for Determining the Rheological Properties of Asphalt Binder Using a Dynamic Shear Rheometer (DSR) (Dynamic Shear)
Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: guadalupe.magana@dot.ca.gov
Organization Phone: (530) 713-6823
Data has not been verified.
