Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215744 DEA: 033H93U4 EFIS: 0321000091
QA Service Level: 1
DIST-CO-RTE-PM: 03-YUB,BUT-70-25.5/25.8,0.0/3.8
Work Description: WIDEN ROADWAY & SHOULDER, ADD TURN LANES & CONSTRUCT BRIDGE.
Location Description: YUBA AND BUTTE COUNTIES ABOUT 11 MILES NORTH OF MARYSVILLE FROM 0.8 MILE NORTH OF CHANDLER ROAD TO 0.2 MILE SOUTH OF EAST GRIDLEY ROAD
Contractor Name: Teichert Construction & MCM JV
Contractor Address: 4401 Duluth Ave, Rocklin, CA 95766
Resident Engineer: Anthony Granados Structure Rep.: Matt Crete
DIME Sample ID: 2022-08-03-74
TL Number from the TL Form: 803703
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Department Acceptance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 08/03/2022
Date that the sample was received by the laboratory/organization performing the testing: 11/01/2022
The quantity of what the sample constitutes: 1qt jug
A brief description of the sample: tack oil 100%
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert
