Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001117 DEA: 033G4304 EFIS: 0324000127
QA Service Level: 1
DIST-CO-RTE-PM: 03-ED-89-0.0/8.5
Work Description: COLD PLANE AC PVMT AND HMA (TYPE A) OVERLAY.
Location Description: EL DORADO COUNTY NEAR MEYERS FROM ALPINE COUNTY LINE TO POMO STREET
Contractor Name: ALL-AMERICAN CONSTRUCTION, INC.
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2026-05-06-11
TL Number from the TL Form:
Sample Submitted By Organization: Blackburn Consulting
Sample Organization Contact: (916) 375-8706
Type of Sample: Quality Assurance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 05/06/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/27/2026
The quantity of what the sample constitutes: 12 Boxes, 5 bags, 2 cans
A brief description of the sample: JMF Verification (Hot Drop)
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Tahoe Asphalt
HMA Type: Type A HMA
HMA Grading: 1/2 inch
Lot number:
Sublot number:
HMA Mix Number: 2001
Binder content (%): 5.1
Virgin binder PG: PG 64-28
Design binder PG:
Binder Supplier: VSS Emultech
RAP content (%): 15
WMA Additives:
Antistrip type: ARKEMA Ad-here XL9000
