Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 66669 DEA: JMF-DATA EFIS: JMF-DATA
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for storing JMF sample data
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2023-04-08-10
TL Number from the TL Form:
Sample Submitted By Organization: Jaxon Enterprises - Deer Creek Rock & Asphalt
Sample Organization Contact: (559) 793-0903
Type of Sample: Quality Control
Type of Material: Antistrip Additive
Sample Taken Date: 04/08/2023
Date that the sample was received by the laboratory/organization performing the testing: 04/10/2023
The quantity of what the sample constitutes: 1 gallon
A brief description of the sample: Morelife 5000
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Ingevity
DIME Test ID: 2023-04-08-10-1
Test Method: ASTM D2074-07r13: Standard Test Methods for Total, Primary, Secondary, and Tertiary Amine Values of Fatty Amines by Alternative Indicator Method (Amine)
Submitted By Organization: Jaxon Enterprises - Deer Creek Rock & Asphalt
Organization Address: 27671 Avenue 120,
Organization City: Porterville
Organization State: CA
Organization Zipcode: 93257
Organization Email: jordanb@jaxonaggregates.com
Organization Phone: (530) 227-0982
Data has not been verified.
