Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1001306 DEA: 023H7704 EFIS: 0218000039
QA Service Level: 1
DIST-CO-RTE-PM: 02-TEH-99-0.0/12.5
Work Description: VINA REHAB: PLACE HMA, INSTALL CULVERTS, AND INSTALL GUARDRAIL.
Location Description: TEHAMA COUNTY IN AND NEAR LOS MOLINOS FROM BUTTE COUNTY LINE TO LOS MOLINOS CREEK BRIDGE
Contractor Name: DeSilva Gates
Contractor Address: 11555 Dublin Boulevard, Dublin, CA 94568
Resident Engineer: Edward Worden Structure Rep.: Unknown
DIME Sample ID: 2026-08-14-77
TL Number from the TL Form: 858083
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: JMF Verification
Type of Material: Crumb Rubber Modifier
Sample Taken Date: 08/14/2026
Date that the sample was received by the laboratory/organization performing the testing: 04/30/2026
The quantity of what the sample constitutes: 1 Bag
A brief description of the sample: Hi Natural Crumb Rubber
From where was the sample collected: Other
Laboratory sample identification: 5180
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: American Tire Recycling
