Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 44444 DEA: ASCP EFIS: ASCP
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for submitting Sample information for Asphalt Supplier Certification Program.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2026-09-10-74
TL Number from the TL Form:
Sample Submitted By Organization: CT D04 - Concord Field Laboratory
Sample Organization Contact: (510) 714-7019
Type of Sample: Quality Control
Type of Material: Asphalt Binder
Sample Taken Date: 09/10/2026
Date that the sample was received by the laboratory/organization performing the testing: 09/10/2026
The quantity of what the sample constitutes: 1 of 1
A brief description of the sample: Tank 2
From where was the sample collected: Manufacturer
Laboratory sample identification: 09182026-02
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Sacramento, CA
Performance Grade: PG 64-16
Modified:
Lot number: 3
Sublot number: 6
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: Cardinal Pacific - McClellan Park CA
Multigrade: Yes
Multigrade Type: PG 64-16 / PG 64-10
Asphalt Binder Mix Number:
HMA Type:
HMA Supplier Mix ID Number:
