Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212845 DEA: 023H1304
QA Service Level: 1
DIST-CO-RTE-PM: 02-LAS-395-47.0/56.5
Work Description: AC OVERLAY, REPLACE AC SURFACE, RUMBLE STRIP, GUARDRAIL
Location Description: LASSEN COUNTY AT AND NEAR JANESVILLE FROM 1.9 MILES SOUTH OF LAKECREST DRIVE TO 0.2 MILE NORTH OF SUNNYSIDE ROAD
Contractor Name: HAT CREEK CONSTRUCTION & MATERIALS, INC.
Contractor Address: Unknown
Resident Engineer: JOHN YOLTON Structure Rep.: Unknown
DIME Sample ID: 2018-05-15-43
TL Number from the TL Form: 894811
Sample Submitted By Organization: CT D02 - Redding Northern Regional Laboratory
Sample Organization Contact: (530) 225-3194
Type of Sample: Verification
Type of Material: Asphalt Binder
Sample Taken Date: 05/15/2018
Date that the sample was received by the laboratory/organization performing the testing: 05/01/2018
The quantity of what the sample constitutes: Cert of Comp
A brief description of the sample: PG 64-28 M
From where was the sample collected: Source
Laboratory sample identification: D77394
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Paramount-Nevada Asphalt Company, Fernley, NV
Performance Grade: PG 64-28 M
Modified:
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier:
Multigrade:
Multigrade Type:
Asphalt Binder Mix Number:
DIME Test ID: 2018-05-15-43-1
Test Method: AASHTO T228-09r13: Standard Method of Test for Specific Gravity of Semi-Solid Asphalt Materials (Specific Gravity)
Verified Date: 08/23/2018
Date Tested: 05/01/2018
Submitted By Organization: CT D02 - Redding Northern Regional Laboratory
Organization Address: 1657 Riverside Drive,
Organization City: Redding
Organization State: CA
Organization Zipcode: 96001
Organization Email: ward.jenkins@dot.ca.gov
Organization Phone: 530-225-3194
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
