Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000279 DEA: 023H70U4 EFIS: 0223000161
QA Service Level: 1
DIST-CO-RTE-PM: 02-TRI-299-15.0/25.7
Work Description: RHMA-G, HMA (TYPE A), COLD PLANE AC, & SOLDIER PILE RETAINING WALL.
Location Description: TRINITY COUNTY NEAR DEL LOMA FROM 1.0 MILE EAST OF TRINITY RIVER BRIDGE NO.05-0006 TO 0.1 MILE WEST OF PRAIRIE CREEK ROAD
Contractor Name: J.F. SHEA CONSTRUCTION, INC.
Contractor Address: Unknown
Resident Engineer: Edward Worden Structure Rep.: Mike Sears
DIME Sample ID: 2025-07-04-1
TL Number from the TL Form: 858522
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: 07/04/2025
Date that the sample was received by the laboratory/organization performing the testing: 08/13/2025
The quantity of what the sample constitutes: 2 Cans
A brief description of the sample: 1/2 RHMA PG 64-16
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Valero
Performance Grade: PG 64-16
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier: Valero
Certified Asphalt Supplier: Valero Marketing & Supply - Benicia CA
Multigrade: Yes
Multigrade Type: PG 64-16 / PG 64-10
Asphalt Binder Mix Number:
