Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001370 DEA: 010K9504 EFIS: 0121000034
QA Service Level: 1
DIST-CO-RTE-PM: 01-DN-101-15.6/16.2
Work Description: PLACE ROADWAY SECTION, INSTALL GUARDRAIL, & EXCAVATE EXISTING ROADWAY.
Location Description: DEL NORTE COUNTY ABOUT 10.0 MILES SOUTH OF CRESCENT CITY FROM 3.0 MILES NORTH TO 3.6 MILES NORTH OF WILSON CREEK BRIDGE
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 1324 S. State Street, Ukiah, CA 95482
Resident Engineer: Nathaniel Steen Structure Rep.: Unknown
DIME Sample ID: 2026-07-22-11
TL Number from the TL Form:
Sample Submitted By Organization: CT D01 - Crescent City Field Laboratory
Sample Organization Contact: (707) 496-5581
Type of Sample: Quality Assurance
Type of Material: Asphalt Binder
Sample Taken Date: 07/22/2026
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 4 qrt cans
A brief description of the sample: binder 64-16
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: western emulsuion
Performance Grade: PG 64-16
Modified:
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier: tidewater
Certified Asphalt Supplier: Western Emulsions - White City Emulsion Plant - White City OR
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
HMA Type: 1/2"
HMA Supplier Mix ID Number: L1917415
