Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 66667 DEA: JMFPP EFIS: 0019000043
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for submitting Sample information for JMF Prequalification Program.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2020-12-28-20
TL Number from the TL Form:
Sample Submitted By Organization: Vulcan Materials Company - Pleasanton
Sample Organization Contact: (925) 260-3017
Type of Sample: Quality Control
Type of Material: Warm Mix Asphalt Technology
Sample Taken Date: 12/28/2020
Date that the sample was received by the laboratory/organization performing the testing: 12/28/2020
The quantity of what the sample constitutes: 1
A brief description of the sample: Evotherm 3G M1
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Ingevity
