Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212861 DEA: 101H2804 EFIS: 1017000190
QA Service Level: 1
DIST-CO-RTE-PM: 10-STA-5-10.7/25.5
Work Description: BRIDGE DECK OVERLAY WITH POLYESTER CONCRETE, REPLACE APPROACH SLABS & JOINT SEALS IN STANISLAUS COUNTY ON STATE ROUTE 5 FROM FINK ROAD UC TO KHALSA ROAD UC.
Location Description: STANISLAUS AND MERCED COUNTIES.
Contractor Name: MYERS & SONS CONSTRUCTION, LLC
Contractor Address: 45 Morrison Avenue, Sacramento, CA 95838
Resident Engineer: Zubair Anwar Structure Rep.: Sai Kasaraneni
DIME Sample ID: 2025-03-01-6
TL Number from the TL Form: 0436011
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: 03/01/2025
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
A brief description of the sample: approval
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Valero Benicia
Performance Grade: PG 64-16
Modified: No
Lot number: 1
Sublot number: 8
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: Valero Marketing & Supply - Benicia CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
