Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002288 DEA: 024K0004
QA Service Level: 1
DIST-CO-RTE-PM: 02---unknown
Work Description:
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2026-06-03-95
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: Asphalt Binder
Sample Taken Date: 06/03/2026
Date that the sample was received by the laboratory/organization performing the testing: 06/08/2026
The quantity of what the sample constitutes: 2, 1 quart cans
A brief description of the sample: 2 CANS OF BINDER
From where was the sample collected: Source
Laboratory sample identification: 80208
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: JF Shea Construction, Fawndale Rock and Asphalt, Redding, CA
Performance Grade: PG 58-22
Modified:
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier: JF SHEA FAWNDALE
Certified Asphalt Supplier: Albina Asphalt - Klamath Falls - Klamath Falls OR
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
HMA Type:
HMA Supplier Mix ID Number:
