Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993572 DEA: 061C5004 EFIS: 0621000172
QA Service Level: 1
DIST-CO-RTE-PM: 06-MAD-145-17.5/25.5
Work Description: RHMA AND HMA PAVING, MODIFY SIGNAL AND LIGHTING SYSTEMS.
Location Description: MADERA COUNTY NEAR MADERA FROM 0.9 MILE SOUTH OF COTTONWOOD CREEK BRIDGE TO ROUTE 41
Contractor Name: Granite Construction
Contractor Address: 2716 S Granite Ct, Fresno, CA 93706
Resident Engineer: Pedro Miguel Structure Rep.: Unknown
DIME Sample ID: 2022-08-17-60
TL Number from the TL Form: 039522
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 Rubber Binder
Sample Taken Date: 08/17/2022
Date that the sample was received by the laboratory/organization performing the testing: 08/24/2022
The quantity of what the sample constitutes: 1 CAN
A brief description of the sample: PG64-16 ARB
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: vulcan madera
Asphalt modifier supplier:
Performance Grade: PG 64-16
Lot number:
Sublot number:
Asphalt Rubber Binder Mix Number:
