Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000608 DEA: 100Q2104 EFIS: 1017000171
QA Service Level: 1
DIST-CO-RTE-PM: 10-AMA-88-5.5/14.3
Work Description: REPAIR FAILED PAVEMENT AND RESURFACE EXISTING PAVEMENT WITH HMA.
Location Description: AMADOR COUNTY NEAR MARTELL FROM 0.7 MILE WEST OF IONE-BUENA VISTA ROAD TO 0.2 MILE EAST OF KENNEDY FLAT ROAD
Contractor Name: BAY CITIES PAVING & GRADING, INC.
Contractor Address: 1450 Civic St. Bldg B #400, Concord, CA 94520
Resident Engineer: Jonathan Ngai Structure Rep.: Unknown
DIME Sample ID: 2025-05-29-115
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Verification
Type of Material: Asphalt Rubber Binder
Sample Taken Date: 05/29/2025
Date that the sample was received by the laboratory/organization performing the testing: 07/29/2025
The quantity of what the sample constitutes: 1 gallon
A brief description of the sample: PG 64-16
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: GRI-CLM
Asphalt modifier supplier:
Performance Grade: PG 64-16
Lot number: 1
Sublot number: 1
Asphalt Rubber Binder Mix Number: