Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994806 DEA: 101P5404 EFIS: 1022000134
QA Service Level: 1
DIST-CO-RTE-PM: 10-SJ-5-R16.2/R23.9
Work Description: Cold plane asphalt concrete pavement and resurface with HMA (Type A).
Location Description: CONSTRUCTION ON STATE HIGHWAY IN SAN JOAQUIN COUNTY IN AND NEAR LATHROP AND STOCKTON AT VARIOUS LOCATIONS FROM 0.3 MILE SOUTH OF LOUISE AVENUE UNDERCROSSING TO WALKER SLOUGH BRIDGE.
Contractor Name: O.C. JONES & SONS, INC.
Contractor Address: 1520 4th Street, Berkeley, CA 94710
Resident Engineer: Jude Dictado Structure Rep.: Unknown
DIME Sample ID: 2023-08-22-64
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Department Acceptance
Type of Material: Asphalt Rubber Binder
Sample Taken Date: 08/22/2023
Date that the sample was received by the laboratory/organization performing the testing: 10/09/2023
The quantity of what the sample constitutes: 2
A brief description of the sample: PG 70-10 Rubberized Binder
From where was the sample collected: Supplier
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Vernalis
Asphalt modifier supplier:
Performance Grade: PG 64-16
Lot number: 2
Sublot number:
Asphalt Rubber Binder Mix Number:
