Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994862 DEA: 051P5604 EFIS: 0522000082
QA Service Level: 1
DIST-CO-RTE-PM: 05-SB-1-30.0/37.5
Work Description: Overlay with rubberized hot mix asphalt - gap graded (BWC).
Location Description: CONSTRUCTION ON STATE HIGHWAY IN SANTA CRUZ COUNTY NEAR DAVENPORT FROM 0.1 MILE SOUTH OF DAVENPORT LANDING ROAD TO SAN MATEO COUNTY LINE.
Contractor Name: PAPICH CONSTRUCTION CO., INC.
Contractor Address: 398 SUNRISE TERRACE;, ARROYO GRANDE CA 93420
Resident Engineer: Martin Jordan Structure Rep.: Unknown
DIME Sample ID: 2023-09-07-23
TL Number from the TL Form:
Sample Submitted By Organization: CT D05 - Monterey Construction Field Laboratory
Sample Organization Contact: 831-818-0254
Type of Sample: Quality Assurance
Type of Material: Asphalt Rubber Binder
Sample Taken Date: 09/07/2023
Date that the sample was received by the laboratory/organization performing the testing: 09/07/2023
The quantity of what the sample constitutes: 2 Cans
A brief description of the sample: 64-16 ARB
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: National Blending Company
Asphalt modifier supplier: San Joaquin Refining Co Inc
Performance Grade: PG 64-16
Lot number:
Sublot number:
Asphalt Rubber Binder Mix Number: 23_1354