Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000760 DEA: 101L2804 EFIS: 1020000103
QA Service Level: 1
DIST-CO-RTE-PM: 10-SJ-4-20.5/20.8
Work Description: INSTALL LEFT-TURN CHANNELIZATION.
Location Description: SAN JOAQUIN COUNTY NEAR STOCKTON FROM 0.2 MILE WEST OF WALKER LANE TO 0.1 MILE EAST OF WALKER LANE
Contractor Name: O.C. JONES & SONS, INC.
Contractor Address: Unknown
Resident Engineer: David Abledu Structure Rep.: Unknown
DIME Sample ID: 2025-10-30-51
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: No Test
Type of Material: Asphalt Binder
Sample Taken Date: 10/30/2025
Date that the sample was received by the laboratory/organization performing the testing: 11/14/2025
The quantity of what the sample constitutes: 2 Cans
A brief description of the sample: 1/2 WMA-SP Rap25%
From where was the sample collected: Job Site
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:
Certified Asphalt Supplier: Pacific Northwest Oil - Stockton CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
