Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212535 DEA: 031A9204 EFIS: 0300020608
QA Service Level: 1
DIST-CO-RTE-PM: 03-SUT-20-5-11.3
Work Description: SUTTER BYPASS WIDENING AND REHAB
Location Description: NEAR YUBA CITY FROM SUTTER BYPASS TO 0.1 MILE WEST OF LYTLE ROAD.
Contractor Name: KNIFE RIVER CONSTRUCTION
Contractor Address: 1764 SKYWAY DR., CHICO, CA 95928
Resident Engineer: Anthony Granados Structure Rep.: Glen Lawson
DIME Sample ID: 2020-09-11-14
TL Number from the TL Form: 766379
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Department Acceptance
Type of Material: Asphalt Rubber Binder
Sample Taken Date: 09/11/2020
Date that the sample was received by the laboratory/organization performing the testing: 09/16/2020
The quantity of what the sample constitutes: 2 can of each sample
A brief description of the sample: ARB 2 cans each, #11, #12(766378), #13(766386), #14(766389) NoTest
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Valero
Asphalt modifier supplier:
Performance Grade: PG 64-16
Lot number:
Sublot number:
Asphalt Rubber Binder Mix Number:
