Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215777 DEA: 032H6304 EFIS: 0317000166
QA Service Level: 1
DIST-CO-RTE-PM: 03-BUT-162-18.4/19.9
Work Description: PLACE RUBBERIZED HMA AND ROADWAY EXCAVATION.
Location Description: BUTTE COUNTY IN AND NEAR OROVILLE FROM FOOTHILL BOULEVARD TO GOLD COUNTRY CASINO ENTRANCE
Contractor Name: DeSilva Gates
Contractor Address: 11555 Dublin Boulevard, Dublin, CA 94568
Resident Engineer: Dwayne Grandy Structure Rep.: Unknown
DIME Sample ID: 2022-09-29-44
TL Number from the TL Form: 803996
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: 09/29/2022
Date that the sample was received by the laboratory/organization performing the testing: 11/15/2022
The quantity of what the sample constitutes: 1 Quart Can
A brief description of the sample: PG64-16
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Valero - Benicia, CA
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:
