Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002657 DEA: 060U6104 EFIS: 0616000052
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-99-unknown
Work Description: Tulare 99 Pumping Plant Repairs
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2026-09-01-45
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Quality Assurance
Type of Material: Asphalt Binder
Sample Taken Date: 09/01/2026
Date that the sample was received by the laboratory/organization performing the testing: 09/14/2026
The quantity of what the sample constitutes: 1 CAN OF 70-10
A brief description of the sample: 70-10
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: NOT ON TL 101
Performance Grade: PG 70-10
Modified:
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier: NOT ON TL 101
Certified Asphalt Supplier: San Joaquin Refinery - Bakersfield CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
HMA Type: 3/4" HMA-A R15
HMA Supplier Mix ID Number: NOT ON TL 101
