Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001940 DEA: 023J52U4 EFIS: 0225000084
QA Service Level: 1
DIST-CO-RTE-PM: 02-TEH-36-15.7/16.4
Work Description: Horse Gulch Combined
Location Description:
Contractor Name: JF Shea Constrcution
Contractor Address: 17400 Clear Creek Road, Redding, CA 96001
Resident Engineer: Damion Farley Structure Rep.: Unknown
DIME Sample ID: 2026-06-25-101
TL Number from the TL Form:
Sample Submitted By Organization: Atlas - Denver
Sample Organization Contact: 303-975-9959
Type of Sample: Quality Assurance
Type of Material: Asphalt Binder
Sample Taken Date: 06/25/2026
Date that the sample was received by the laboratory/organization performing the testing: 07/01/2026
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: 080205
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: JF SHEA CLEAR CREEK
Performance Grade: PG 58-22
Modified:
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier: JF SHEA CLEAR CREEK
Certified Asphalt Supplier: Albina Asphalt - Klamath Falls - Klamath Falls OR
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
