Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000513 DEA: 020J8504 EFIS: 0219000168
QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-89-21/R34.622
Work Description: MCCLOUD CAPM - PAVEMENT REHABILITATION
Location Description: IN SISKIYOU COUNTY AT AND NEAR MCCLOUD FROM 0.1 MILE SOUTH OF MUD CREEK BRIDGE TO ROUTE 5
Contractor Name: TULLIS, INC.
Contractor Address: Unknown
Resident Engineer: Austin Henry Structure Rep.: Unknown
DIME Sample ID: 2026-07-14-110
TL Number from the TL Form: 846251
Sample Submitted By Organization: CT D02 - Redding Northern Regional Laboratory
Sample Organization Contact: (530) 225-3194
Type of Sample: Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 07/14/2026
Date that the sample was received by the laboratory/organization performing the testing: 07/14/2026
The quantity of what the sample constitutes: 750 Tons
A brief description of the sample: 16 boxes of Lime Treated 1/2-inch RHMA-G (PG 64-16 CR) virgin PG 64-16 from Valero – Benicia
From where was the sample collected: Manufacturer
Laboratory sample identification: D80282
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Tullis Inc. - Northstate Asphalt (Redding CA)
HMA Type: RHMA-G
HMA Grading: 1/2 inch
Lot number:
Sublot number:
HMA Mix Number:
Binder content (%): 7.6
Virgin binder PG: PG 58-22
Design binder PG: PG 58-22
Binder Supplier: Albina (Klamath Falls, OR)
RAP content (%): 0
WMA Additives: No
Antistrip type: 1.0% Lime
DIME Test ID: 2026-07-14-110-1
Test Method: AASHTO T209-12: Standard Method of Test for Theoretical Maximum Specific Gravity (Gmm) and Density of Asphalt Mixtures (Maximum Specific Gravity)
Submitted By Organization: CT D02 - Redding Northern Regional Laboratory
Organization Address: 1657 Riverside Drive,
Organization City: Redding
Organization State: CA
Organization Zipcode: 96001
Organization Email: ward.jenkins@dot.ca.gov
Organization Phone: 530-225-3194
Data has not been verified.
