Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1002520 DEA: 061J0104 EFIS: 0625000108
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-216-13.6/19.3
Work Description: HMA (Type A) + Polymer Seal/Flush Coat (ChipSeal), Signs, Striping, TMS. HMA (Type A), polymer asphaltic emulsion and aggregate (seal coat).
Location Description: RTE 216 WOODLAKE - CYPRESS AVE (N) TO RTE 198, TULARE.
Contractor Name: Doolittle Construction, LLC dba Doolittle Road Construction (George Bobian)
Contractor Address: P.O. Box 1819, Snoqualmie, WA 98065
Resident Engineer: Hugo Camberos Structure Rep.: None None
DIME Sample ID: 2026-09-12-27
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: No Test
Type of Material: Asphaltic Emulsion
Sample Taken Date: 09/12/2026
Date that the sample was received by the laboratory/organization performing the testing: 09/29/2026
The quantity of what the sample constitutes: 1 of 2
A brief description of the sample: pmcrs-2h
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Talley Oil - Madera
