Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 44444 DEA: ASCP EFIS: ASCP
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for submitting Sample information for Asphalt Supplier Certification Program.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2025-10-13-39
TL Number from the TL Form:
Sample Submitted By Organization: ABT Group
Sample Organization Contact: (949) 690-1411
Type of Sample: Verification
Type of Material: Asphalt Binder
Sample Taken Date: 10/13/2025
Date that the sample was received by the laboratory/organization performing the testing: 11/24/2025
The quantity of what the sample constitutes: 2 of 2 can, initial testing new PG
A brief description of the sample: Asphalt Binder PG58-22
From where was the sample collected: Manufacturer
Laboratory sample identification: 5822251013
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: San Joaquin Refinery, Bakersfield, CAopop
Performance Grade: PG 58-22
Modified: No
Lot number: 5822251013
Sublot number:
Tank number: 2002
Time of sample: 9:00
HMA Supplier:
Certified Asphalt Supplier: San Joaquin Refinery - Bakersfield CA
Multigrade: Yes
Multigrade Type: PG 58-22 / PG 58-16
Asphalt Binder Mix Number:
