Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 214986 DEA: 041J9704 EFIS: 0414000404
QA Service Level: 1
DIST-CO-RTE-PM: 04-SCL-17-2.8/13.94
Work Description: PAVING WITH RHMA, COLD PLANE AC, AND INSTALL CULVERT.
Location Description: SANTA CLARA COUNTY IN AND NEAR LOS GATOS, CAMPBELL AND SAN JOSE FROM HEBARD ROAD TO ROUTE 17/280 SEPARATION
Contractor Name: GRANITE ROCK COMPANY
Contractor Address: 120 Granite Rock, San Jose, CA 95136
Resident Engineer: Ali Nikzad Structure Rep.: Unknown
DIME Sample ID: 2023-04-18-94
TL Number from the TL Form: TL-C927716
Sample Submitted By Organization: CT D04 - Concord Field Laboratory
Sample Organization Contact: (510) 714-7019
Type of Sample: Production Start-Up
Type of Material: Asphalt Rubber Binder
Sample Taken Date: 04/18/2023
Date that the sample was received by the laboratory/organization performing the testing: 04/18/2023
The quantity of what the sample constitutes: 104 Tons
A brief description of the sample: 3/4 RHMA-G
From where was the sample collected: Manufacturer
Laboratory sample identification: SJ-041823-OC2
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Rock Wilson Aromas Batch
Asphalt modifier supplier:
Performance Grade: PG 64-16
Lot number: 1
Sublot number: 102
Asphalt Rubber Binder Mix Number:
