Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214588 DEA: 020J1504 EFIS: 0219000066
QA Service Level: 1
DIST-CO-RTE-PM: 02-SHA,TEH-36-4.0/8.0,13.0/17.0
Work Description: PLACE HMA (TYPE A), REPLACE AC SURFACING AND GUARDRAIL.
Location Description: SHASTA AND TEHAMA COUNTIES NEAR PLATINA FROM 0.3 MILE EAST OF HARRISON GULCH ROAD TO 0.8 MILE WEST OF PLATINA ROAD AND FROM 2.6 MILES EAST OF DRY CREEK BRIDGE TO 2.1 MILES WEST OF SALT CREEK BRIDGE
Contractor Name: TULLIS, INC.
Contractor Address: 16951 CLEAR CREEK ROAD, REDDING CA 96001
Resident Engineer: Structure Rep.: Unknown
DIME Sample ID: 2020-10-09-27
TL Number from the TL Form: None
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: 10/09/2020
Date that the sample was received by the laboratory/organization performing the testing: 10/30/2020
The quantity of what the sample constitutes: 1 gallon can
A brief description of the sample: PG 58-34M #6 No Test
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: valero benicia
Performance Grade: PG 58-34 M
Modified: Yes
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier:
Multigrade:
Multigrade Type:
Asphalt Binder Mix Number:
