Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002542 DEA: 101U0404 EFIS: 1025000084
QA Service Level: 1
DIST-CO-RTE-PM: 10-SJ-26-unk1.1/8.0, 10.1/11.0known
Work Description: Cold plane, HMA, RHMA, slurry seal, and signal and lighting systems
Location Description: FROM 0.3 MILE WEST OF ORO AVENUE TO 0.9 MILE WEST OF MURRAY ROAD AND AT LINDEN FROM 0.1 MILE EAST OF DUNCAN ROAD TO 0.2 MILE EAST OF MARKET STREET In District 10 On Route 26
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2026-07-30-85
TL Number from the TL Form: 850392
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 Rubber Binder
Sample Taken Date: 07/30/2026
Date that the sample was received by the laboratory/organization performing the testing: 08/11/2026
The quantity of what the sample constitutes: 1 Quart Can
A brief description of the sample: 1 can of rubberized binder
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: George Reed Munn & Perkins Plant
Asphalt modifier supplier:
Performance Grade: PG 64-16
Lot number:
Sublot number:
Asphalt Rubber Binder Mix Number:
