Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214907 DEA: 101K4204 EFIS: 1019000103
QA Service Level: 1
DIST-CO-RTE-PM: 10-MER,STA-165-30.6/36.7,0.0/1.6
Work Description: COLD PLANE AC PAVEMENT, RESURFACE WITH RHMA, AND MICRO-SURFACING.
Location Description: MERCED COUNTY IN AND NEAR HILMAR FROM MERCED RIVER BRIDGE TO STANISLAUS COUNTY LINE AND IN STANISLAUS COUNTY NEAR TURLOCK FROM MERCED COUNTY LINE TO ROUTE 99/165 SEPARATION
Contractor Name: TEICHERT CONSTRUCTION
Contractor Address: 400 SUNRISE AVE. SUITE 300;, ROSEVILLE CA 95661
Resident Engineer: Vince Ladiao Structure Rep.: Unknown
DIME Sample ID: 2020-09-17-17
TL Number from the TL Form: 034041
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 Binder
Sample Taken Date: 09/17/2020
Date that the sample was received by the laboratory/organization performing the testing: 09/25/2020
The quantity of what the sample constitutes: 1 can
A brief description of the sample: PG 64-16 Asphalt Binder #3(034041), #4(034051), #5(034056) No Test
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: FNF AC INDUSTRIES
Performance Grade: PG 64-16
Modified: No
Lot number: 1
Sublot number: 10
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier:
Multigrade:
Multigrade Type:
Asphalt Binder Mix Number:
