Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000282 DEA: 033G0704 EFIS: 0323000121
QA Service Level: 1
DIST-CO-RTE-PM: 03-BUT-32-31.5/37.8
Work Description: COLD PLANE AND PLACE HMA.
Location Description: BUTTE COUNTY FROM 1.6 MILES NORTH OF 120G/PLATT MOUNTAIN ROAD TO TEHAMA COUNTY LINE
Contractor Name: LAMON CONSTRUCTION CO., INC.
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2025-06-11-90
TL Number from the TL Form: 778837
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: 06/11/2025
Date that the sample was received by the laboratory/organization performing the testing: 06/30/2025
The quantity of what the sample constitutes: 1
A brief description of the sample: 1 can
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Hallwood
Performance Grade: PG 58-22
Modified: No
Lot number: 1
Sublot number: 4
Tank number:
Time of sample:
HMA Supplier: Teichert Hallwood
Certified Asphalt Supplier: Pacific Northwest Oil - Stockton CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
