Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994555 DEA: 032G7504 EFIS: 0322000154
QA Service Level: 1
DIST-CO-RTE-PM: 03-GLE-45-7.0/23.2
Work Description: FULL AND PARTIAL DEPTH RECYCLING, PLACE RHMA.
Location Description: GLENN COUNTY NEAR HAMILTON CITY FROM 4.4 MILES SOUTH TO 1.4 MILES NORTH OF BAYLISS BLUE GUM ROAD AND FROM 3.5 MILES SOUTH TO 2.5 MILES NORTH OF STONY CREEK BRIDGE
Contractor Name: BALDWIN CONTRACTING CO., INC. DBA KNIFE RIVER CONSTRUCTION
Contractor Address: 1764 Skyway, Chico, CA 95928
Resident Engineer: Dwayne Grandy Structure Rep.: Not Applicable
DIME Sample ID: 2023-09-20-83
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Department Acceptance
Type of Material: Asphalt Rubber Binder
Sample Taken Date: 09/20/2023
Date that the sample was received by the laboratory/organization performing the testing: 10/13/2023
The quantity of what the sample constitutes: 1 of 1 can
A brief description of the sample: PG 64-16
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Knife River, Orland
Asphalt modifier supplier:
Performance Grade: PG 64-16
Lot number: 1
Sublot number: 10
Asphalt Rubber Binder Mix Number:
