Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 993208 DEA: 034F38U4 EFIS: 0321000092
QA Service Level: 1
DIST-CO-RTE-PM: 03-YUB-70-16.2/25.8
Work Description: WIDEN SHOULDERS AND IMPROVE CLEAR RECOVERY ZONE.
Location Description: YUBA COUNTY NEAR MARYSVILLE FROM 0.2 MILE NORTH OF LAURELLEN ROAD TO SOUTH HONCUT CREEK BRIDGE
Contractor Name: DeSilva Gates
Contractor Address: 11555 Dublin Boulevard, Dublin, CA 94568
Resident Engineer: Manoharan Selvendran Structure Rep.: Unknown
DIME Sample ID: 2022-10-13-63
TL Number from the TL Form: 802331
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: 10/13/2022
Date that the sample was received by the laboratory/organization performing the testing: 11/14/2022
The quantity of what the sample constitutes: 1 of 1
A brief description of the sample: PG58-22
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Valero - Benicia, CA
Performance Grade: PG 58-22
Modified: No
Lot number: 6
Sublot number: 8
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: Valero Marketing & Supply - Benicia CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
