Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000225 DEA: 023J3204 EFIS: 0222000034
QA Service Level: 1
DIST-CO-RTE-PM: 02-TRI-3,36,299-Var
Work Description: BRIDGE POLYESTER CONCRETE OVERLAY & METHACRYLATE DECK SEAL.
Location Description: TRINITY COUNTY AT VARIOUS LOCATIONS
Contractor Name: Q&D CONSTRUCTION, LLC
Contractor Address: Unknown
Resident Engineer: Edward Worden Structure Rep.: Unknown
DIME Sample ID: 2025-07-21-23
TL Number from the TL Form: C824078
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Quality Assurance
Type of Material: Asphalt Binder
Sample Taken Date: 07/21/2025
Date that the sample was received by the laboratory/organization performing the testing: 07/25/2025
The quantity of what the sample constitutes: 2 cans of binder
A brief description of the sample: 58-34M
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Valero
Performance Grade: PG 58-34 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:
