Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002670 DEA: 010L2204 EFIS: 0121000085
QA Service Level: 1
DIST-CO-RTE-PM: 01-LAK-29-17.6/18
Work Description: Lake-29/ C St Left Turn Channelization
Location Description:
Contractor Name: GHILOTTI CONSTRUCTION CO. INC.
Contractor Address: 246 GHILOTTI AVE., SANTA ROSA, CA 95407
Resident Engineer: Roozbeh Hadipour Structure Rep.: Unknown
DIME Sample ID: 2026-09-09-56
TL Number from the TL Form: 036211
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Production Start-Up
Type of Material: Asphalt Binder
Sample Taken Date: 09/09/2026
Date that the sample was received by the laboratory/organization performing the testing: 09/21/2026
The quantity of what the sample constitutes: 1 Can
A brief description of the sample: 1 can of PG 58-22 binder
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite- Ukiah
Performance Grade: PG 58-22
Modified:
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier: Granite- Ukiah
Certified Asphalt Supplier: Valero Benicia Refinery - Benicia CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
HMA Type: 3/4" HMA-A 25% RAP
HMA Supplier Mix ID Number: 15368
DIME Test ID: 2026-09-09-56-1
Test Method: AASHTO T315-24: Standard Method of Test for Determining the Rheological Properties of Asphalt Binder Using a Dynamic Shear Rheometer (DSR) (Dynamic Shear)
Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: guadalupe.magana@dot.ca.gov
Organization Phone: (530) 713-6823
Data has not been verified.
