Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001389 DEA: 030J5204 EFIS: 0319000293
QA Service Level: 1
DIST-CO-RTE-PM: 03-NEV,PLA-20-Var
Work Description: CAPITAL PREVENTIVE MAINTENANCE (CAPM) - COLD PLANE AC PVMT, HMA (TYPE A), & DRAINAGE SYSTEMS.
Location Description: NEVADA AND PLACER COUNTIES AT VARIOUS LOCATIONS FROM 0.1 MILE EAST OF DOW ROAD TO 0.5 MILE EAST OF YUBA PASS SEPARATION AND OVERHEAD
Contractor Name: KNIFE RIVER COMPANY
Contractor Address: 1764 SKYWAY, CHICO, CA 95928
Resident Engineer: Lucas Price Structure Rep.: Unknown
DIME Sample ID: 2026-05-11-14
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: 05/11/2026
Date that the sample was received by the laboratory/organization performing the testing: 05/11/2026
The quantity of what the sample constitutes: 12 Boxes, 5 bags, 4 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: Knife River (Hallwood)
HMA Type: Type A HMA
HMA Grading: 3/4 inch
Lot number:
Sublot number:
HMA Mix Number: HR22771900
Binder content (%): 4.5
Virgin binder PG: PG 58-22
Design binder PG: PG 58-22
Binder Supplier: Pacific Northwest Oil
RAP content (%): 25
WMA Additives:
Antistrip type:
