Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215734 DEA: 024H0104 EFIS: 0218000068
QA Service Level: 1
DIST-CO-RTE-PM: 02-PLU-70-78.3/90.3
Work Description: REPLACE AC SURFACING, PLACE HMA AND THERMOPLASTIC TRAFFIC STRIPING.
Location Description: PLUMAS COUNTY NEAR PORTOLA FROM 0.4 MILE WEST OF BIG GRIZZLY CREEK BRIDGE TO 0.8 MILE WEST OF SUMMIT SCHOOL DRIVE
Contractor Name: HAT CREEK CONSTRUCTION & MATERIALS, INC.
Contractor Address: 243339 Hwy 89, N Burney, CA 96013
Resident Engineer: Mike Zdenek Structure Rep.: Unknown
DIME Sample ID: 2025-07-22-62
TL Number from the TL Form:
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: 07/22/2025
Date that the sample was received by the laboratory/organization performing the testing: 07/31/2025
The quantity of what the sample constitutes: 2 cans
A brief description of the sample: Asphalt Binder PG58-22
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Albina
Performance Grade: PG 58-22
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier: Hat Creek
Certified Asphalt Supplier: Albina Asphalt - Chowchilla CA
Multigrade: No
Multigrade Type: PG 58-22 / PG 58-16
Asphalt Binder Mix Number:
