Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002527 DEA: 033G7504 EFIS: 0325000106
QA Service Level: 1
DIST-CO-RTE-PM: 03-BUT-191-0.0/3.4,3.7/6.8
Work Description:
Location Description:
Contractor Name: LAMON CONSTRUCTION
Contractor Address: 871 Von Geldern Way., Yuba City, CA, 95991
Resident Engineer: Husam Makhoul Structure Rep.: Unknown
DIME Sample ID: 2026-08-10-9
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: Asphalt Binder
Sample Taken Date: 08/10/2026
Date that the sample was received by the laboratory/organization performing the testing: 08/10/2026
The quantity of what the sample constitutes: 1 Can
A brief description of the sample: PG 64-16
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Hallwood
Performance Grade: PG 64-16
Modified:
Lot number: 1
Sublot number: 1
Tank number:
Time of sample:
HMA Supplier: Teichert Hallwood
Certified Asphalt Supplier: Pacific Northwest Oil - Stockton CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
HMA Type: 1/2 RHMA PG 64-16
HMA Supplier Mix ID Number: 30940542500P
