Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993426 DEA: 061C3604 EFIS: 0621000162
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-63-0.0/2.0
Work Description: COLD PLANE AC, PLACE HMA (TYPE A) AND RHMA-G.
Location Description: TULARE COUNTY IN AND NEAR TULARE FROM ROUTE 137 TO EAST CARTMILL AVENUE
Contractor Name: Cal Valley Construction
Contractor Address: 5125 N. Gates Ave., Ste. 102, Fresno, CA, 93722-6414
Resident Engineer: Haidar Haddadin Structure Rep.: Unknown
DIME Sample ID: 2022-05-24-35
TL Number from the TL Form: C772664
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: 05/24/2022
Date that the sample was received by the laboratory/organization performing the testing: 06/01/2022
The quantity of what the sample constitutes: 1 OF 1
A brief description of the sample: BINDER
From where was the sample collected: Other
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: San Joaquin Refinery
Performance Grade: PG 64-10
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: San Joaquin Refinery - Bakersfield CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
