Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000641 DEA: 080G8504 EFIS: 0815000218
QA Service Level: 1
DIST-CO-RTE-PM: 08-RIV-10-R71.2/R72.6
Work Description: BUILDING WORK.
Location Description: RIVERSIDE COUNTY NEAR INDIO FROM 0.9 MILE WEST TO 0.5 MILE EAST OF THE CACTUS CITY SAFETY ROADSIDE REST AREAS
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: Unknown
Resident Engineer: Khoi Vu Structure Rep.: Unknown
DIME Sample ID: 2025-09-03-9
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Concrete Testing Laboratory
Sample Organization Contact: (916) 206-4373
Type of Sample: Quality Control
Type of Material: Asphalt Binder
Sample Taken Date: 09/03/2025
Date that the sample was received by the laboratory/organization performing the testing: 09/03/2025
The quantity of what the sample constitutes: 333
A brief description of the sample: 222
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: 22222
Performance Grade: PG 64-10
Modified: Yes
Lot number: 3
Sublot number: 1
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: Ergon Asphalt & Emulsions Incorporated - Las Vegas NV
Multigrade: Yes
Multigrade Type: PG 64-16 / PG 64-10
Asphalt Binder Mix Number:
