Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001562 DEA: 010H5704 EFIS: 0117000237
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-101-20.9/28.6
Work Description: PLACE ASPHALT, VEGETATION CONTROL & INSTALL HIGH TENSION CABLE BARRIER
Location Description: MENDOCINO COUNTY IN AND NEAR UKIAH FROM NORTH OF ROBINSON CREEK BRIDGE TO POMO LANE UNDERCROSSING
Contractor Name: Ghilott Bros., Inc.
Contractor Address: 525 Jacoby Street, San Rafael, CA 94901
Resident Engineer: Daniel Kraft Structure Rep.: Unknown
DIME Sample ID: 2026-04-16-33
TL Number from the TL Form: 900184
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Acceptance
Type of Material: Asphalt Binder
Sample Taken Date: 04/16/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/22/2026
The quantity of what the sample constitutes: 1 can
A brief description of the sample: JMF Verification
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Ukiah
Performance Grade: PG 58-22
Modified:
Lot number:
Sublot number:
Tank number: JMF Verification
Time of sample:
HMA Supplier: Granite Ukiah
Certified Asphalt Supplier: Valero Benicia Refinery - Benicia CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
DIME Test ID: 2026-04-16-33-1
Test Method: AASHTO T315-24: Standard Method of Test for Determining the Rheological Properties of Asphalt Binder Using a Dynamic Shear Rheometer (DSR) (Dynamic Shear)
Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: guadalupe.magana@dot.ca.gov
Organization Phone: (530) 713-6823
Data has not been verified.
