Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 55555 DEA: AMRL EFIS: AMRL
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for submitting Sample information for AASHTO Materials Reference Laboratory (AMRL).
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2023-05-18-65
TL Number from the TL Form:
Sample Submitted By Organization: CT - Unassigned/General Field Laboratory
Sample Organization Contact: 5625005861
Type of Sample: Proficiency
Type of Material: Asphalt Binder
Sample Taken Date: 05/18/2023
Date that the sample was received by the laboratory/organization performing the testing: 05/18/2023
The quantity of what the sample constitutes: 1 Quart Can
A brief description of the sample: PSP 0271A
From where was the sample collected: Other
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AASHTO Resouces
Performance Grade: PG 76-22 M
Modified: Yes
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: AASHTO Resource - Frederick MD
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
