Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993801 DEA: 032G3704 EFIS: 0321000118
QA Service Level: 1
DIST-CO-RTE-PM: 03-COL,YOL-16-0.1/7.3,0.0/0.7
Work Description: PARTIAL DEPTH RECYCLING, PLACE RHMA-G, & COLD PLANE AC PAVEMENT.
Location Description: COLUSA AND YOLO COUNTIES NEAR RUMSEY FROM 0.1 MILE SOUTH OF ROUTE 20 TO 1.3 MILES NORTH OF ROAD 40
Contractor Name: BALDWIN CONTRACTING CO. INC DBA KNIFE RIVER CONSTRUCTION
Contractor Address: 1764 SKYWAY ROAD, CHICO, CA 95928
Resident Engineer: Masoud Saed Structure Rep.: Unknown
DIME Sample ID: 2022-10-04-15
TL Number from the TL Form: 849185
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: 10/04/2022
Date that the sample was received by the laboratory/organization performing the testing: 10/04/2022
The quantity of what the sample constitutes: 5 cans
A brief description of the sample: 64-16 Blend
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Valero
Performance Grade: PG 64-16
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: Valero Marketing & Supply - Benicia CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
