Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215607 DEA: 061C6504 EFIS: 0621000099
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-41-R0.5/M5.9
Work Description: RESURFACE AC PAVEMENT AND INSTALL MEDIAN TYPE K CONCRETE BARRIER.
Location Description: FRESNO COUNTY ABOUT 6 MILES NORTH OF LEMOORE FROM 0.5 MILE NORTH OF EXCELSIOR AVENUE UNDERCROSSING TO 0.2 MILE SOUTH OF ELKHORN AVENUE
Contractor Name: Cal Valley Construction
Contractor Address: 5125 N. Gates Ave., Ste. 102, Fresno, CA, 93722-6414
Resident Engineer: Mark Mengoni Structure Rep.: Unknown
DIME Sample ID: 2021-06-23-14
TL Number from the TL Form: c040389
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: 06/23/2021
Date that the sample was received by the laboratory/organization performing the testing: 06/30/2021
The quantity of what the sample constitutes: 1 can
A brief description of the sample: PG64-16
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite - Coalinga
Performance Grade: PG 64-16
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier: Granite - Coalinga
Certified Asphalt Supplier: San Joaquin Refinery - Bakersfield CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
