Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993331 DEA: 023H6904 EFIS: 0218000010
QA Service Level: 1
DIST-CO-RTE-PM: 02-PLU-89-30/R42.1
Work Description: ALMANOR WEST REHAB - ROADWAY REHABILITATION
Location Description: IN PLUMAS COUNTY NEAR CANYON DAM FROM LAKE ALMANOR SPILLWAY TO ROUTE 36.
Contractor Name: DIG IT CONSTRUCTION, INC.
Contractor Address: Unknown
Resident Engineer: Sergio Mendoza Structure Rep.: Unknown
DIME Sample ID: 2026-09-23-55
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: Asphalt Binder
Sample Taken Date: 09/23/2026
Date that the sample was received by the laboratory/organization performing the testing: 10/02/2026
The quantity of what the sample constitutes: 2 cans
A brief description of the sample: 2 CANS PG 64-16
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Albina - Klamath Falls, OR
Performance Grade: PG 64-16
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier: DIG IT-Sierra Cascade Chester Plant
Certified Asphalt Supplier: Albina Asphalt - Klamath Falls - Klamath Falls OR
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
HMA Type: 1/2" HMA-A 24% RAP
HMA Supplier Mix ID Number: Not on TL-101
