Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995125 DEA: 101E3004 EFIS: 1018000273
QA Service Level: 1
DIST-CO-RTE-PM: 10-SJ-5-32.5/49.8
Work Description: REMOVE EXISTING PAVEMENT AND REPLACE WITH CONCRETE PAVEMENT.
Location Description: SAN JOAQUIN COUNTY IN AND NEAR STOCKTON FROM 0.2 MILE SOUTH OF HAMMER LANE UNDERCROSSING TO SACRAMENTO COUNTY LINE
Contractor Name: BAY CITIES PAVING & GRADING, INC.
Contractor Address: 1450 Civic Court, Building B #400, Concord, CA 95351
Resident Engineer: Ariel Mendoza Structure Rep.: Unknown
DIME Sample ID: 2025-04-17-97
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: Quality Assurance
Type of Material: Asphalt Binder
Sample Taken Date: 04/17/2025
Date that the sample was received by the laboratory/organization performing the testing: 07/30/2025
The quantity of what the sample constitutes: 1 CAN PG 64-16
A brief description of the sample: 3/4 Type A HMA W/22%RAP
From where was the sample collected: Manufacturer
Laboratory sample identification: I-5 PAVING
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Vernalis
Performance Grade: PG 64-16
Modified: No
Lot number: 7
Sublot number: 5
Tank number:
Time of sample:
HMA Supplier: Teichert Vernalis Plant
Certified Asphalt Supplier: Pacific Northwest Oil - Stockton CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
