Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000887 DEA: 061G8404 EFIS: 0624000170
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-99-13.5/19.5
Work Description: COLD PLANE AC PAVEMENT AND HMA.
Location Description: TULARE COUNTY AT TIPTON FROM 0.1 MILE NORTH OF ROAD 124 ON RAMP TO AVENUE 152 OVERCROSSING
Contractor Name: ARCHER CIVIL CONSTRUCTION, LLC
Contractor Address: Unknown
Resident Engineer: Cesar Mandujano Structure Rep.: Unknown
DIME Sample ID: 2025-10-29-62
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: Asphaltic Emulsion
Sample Taken Date: 10/29/2025
Date that the sample was received by the laboratory/organization performing the testing: 12/12/2025
The quantity of what the sample constitutes: 1 JUG OF EMULSION
A brief description of the sample: SS-1H 80/20
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Centennial Asphalt
