Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000996 DEA: 101S6404 EFIS: 1024000105
QA Service Level: 1
DIST-CO-RTE-PM: 10-MER-165-L0.0/7.0,8.7/16.5
Work Description: RESURFACE PAVEMENT WITH RHMA AND HMA.
Location Description: MERCED COUNTY IN AND NEAR LOS BANOS FROM 0.3 MILE SOUTH OF POLE LINE ROAD TO 0.2 MILE SOUTH OF MASON ROAD AND FROM 0.1 MILE SOUTH OF CANAL FARM LANE TO 1.4 MILES NORTH OF WOLFSEN ROAD
Contractor Name: A. TEICHERT & SON, INC. DBA TEICHERT CONSTRUCTION
Contractor Address: Unknown
Resident Engineer: Jagga Dhami Structure Rep.: Unknown
DIME Sample ID: 2025-08-14-97
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: 08/14/2025
Date that the sample was received by the laboratory/organization performing the testing: 08/20/2025
The quantity of what the sample constitutes: 1 Can
A brief description of the sample: 1/2 WMA-SP
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Santa Fe Aggregate
Performance Grade: PG 64-28 M
Modified: Yes
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier: Teichert- Santa Fe Aggregates
Certified Asphalt Supplier: Albina Asphalt - Chowchilla CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
