Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000927 DEA: 101R7204 EFIS: 1023000209
QA Service Level: 1
DIST-CO-RTE-PM: 10-SJ-5,99-Var
Work Description: PLACE POLYESTER CONCRETE OVERLAY, TRAFFIC STRIPE, COLD PLANE, AND HMA.
Location Description: SAN JOAQUIN COUNTY AT VARIOUS LOCATIONS
Contractor Name: MCCUEN CONSTRUCTION, INC.
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2025-11-02-8
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: 11/02/2025
Date that the sample was received by the laboratory/organization performing the testing: 11/14/2025
The quantity of what the sample constitutes: 1 Can
A brief description of the sample: 3/4 WMA w/25%Rap
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Vernalis
Performance Grade: PG 64-16
Modified:
Lot number: 1
Sublot number: 1
Tank number:
Time of sample:
HMA Supplier: Teichert Vernalis
Certified Asphalt Supplier: Pacific Northwest Oil - Stockton CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
