Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215425 DEA: 06360244 EFIS: 0613000005
QA Service Level: 1
DIST-CO-RTE-PM: 06-TUL-99-30.6/35.2
Work Description: Widen Freeway & Bridge Construction (Concrete Bridge)
Location Description:
Contractor Name: SECURITY PAVING COMPANY, INC.
Contractor Address: 13170 TELFAIR AVE, SYLMAR, CA, 91342
Resident Engineer: Javier Huerta Structure Rep.: Ramandeep Guraya
DIME Sample ID: 2023-07-17-29
TL Number from the TL Form:
Sample Submitted By Organization: CT D06 - Visalia Field Laboratory
Sample Organization Contact: (559) 974-1304
Type of Sample: Quality Assurance
Type of Material: Asphalt Binder
Sample Taken Date: 07/17/2023
Date that the sample was received by the laboratory/organization performing the testing: 07/17/2023
The quantity of what the sample constitutes: 350 Tons
A brief description of the sample: 3/4 HMA-A RAP 15%
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name: NB TUL 99 - Ave 264 Tagus
The fabricator/manufacturer/facility name: Porterville Rock and Recycle PAI
Performance Grade: PG 64-10
Modified:
Lot number: 3
Sublot number: 30
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: San Joaquin Refinery - Bakersfield CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
