Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215677 DEA: 044G0804 EFIS: 0412000332 COOP: 042676
QA Service Level: 1
DIST-CO-RTE-PM: 04-SOL-80-R10.4/30.2
Work Description: Highway widening, overhead signs, and electronic toll system.
Location Description: In Solano County in Fairfield and Vacaville from 1.0 mile west of Red Top Road Undercrossing to 0.4 mile east of Leisure Town Road Overcrossing.
Contractor Name: O.C. JONES & SONS, INC.
Contractor Address: 1520 Fourth Street, Berkeley, CA 94710
Resident Engineer: Justen Tatum Structure Rep.: Kelsey Littell
DIME Sample ID: 2023-03-02-24
TL Number from the TL Form: C727145
Sample Submitted By Organization: CT D04 - Concord Field Laboratory
Sample Organization Contact: (510) 714-7019
Type of Sample: Quality Assurance
Type of Material: Asphalt Binder
Sample Taken Date: 03/02/2023
Date that the sample was received by the laboratory/organization performing the testing: 03/03/2023
The quantity of what the sample constitutes: 750 Tons
A brief description of the sample: Drum - 3/4" HMA
From where was the sample collected: Manufacturer
Laboratory sample identification: Con_23_ 179
Structure unique identifier:
Structure name: HWY 80
The fabricator/manufacturer/facility name: Vulcan - Vallejo
Performance Grade: PG 64-16
Modified: No
Lot number: 6
Sublot number: 8
Tank number:
Time of sample: 03/02/2023
HMA Supplier: Vulcan - Vallejo
Certified Asphalt Supplier: Valero Marketing & Supply - Benicia CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
