Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000363 DEA: 010H5504 EFIS: 0117000235
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-101-55.0/64.9
Work Description: HMA, RHMA, AND COLD PLANE ASPHALT CONCRETE PAVEMENT.
Location Description: MENDOCINO COUNTY NEAR LONGVALE FROM 2.6 MILES SOUTH OF ARNOLD BRIDGE OVERHEAD 10-179 TO 0.1 MILE NORTH OF LONG VALLEY CREEK BRIDGE 10-99
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 1324 S. State Street, Ukiah, CA 95482
Resident Engineer: Daniel Kraft Structure Rep.: Hayden Terrill
DIME Sample ID: 2025-08-08-20
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: Asphaltic Emulsion
Sample Taken Date: 08/08/2025
Date that the sample was received by the laboratory/organization performing the testing: 08/18/2025
The quantity of what the sample constitutes: 2 jugs
A brief description of the sample: tack coat 100%
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Pacific Northwest Oil
