Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994553 DEA: 032G7204 EFIS: 0322000151
QA Service Level: 1
DIST-CO-RTE-PM: 03-YOL-113-R10.1/R10.8
Work Description: JOINTED PLAIN CONC PVMT, INDIVIDUAL SLAB REPL, & REMOVE CONC PVMT.
Location Description: YOLO COUNTY IN WOODLAND FROM 0.1 MILE SOUTH OF EAST WOODLAND OVERHEAD TO 0.1 MILE SOUTH OF S5/S113 CONNECTOR UNDERCROSSING
Contractor Name: FBD VANGUARD CONSTRUCTION INC
Contractor Address: Unknown
Resident Engineer: Jody Phillips Structure Rep.: Unknown
DIME Sample ID: 2023-12-15-50
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: Quality Assurance
Type of Material: Asphalt Binder
Sample Taken Date: 12/15/2023
Date that the sample was received by the laboratory/organization performing the testing: 01/02/2024
The quantity of what the sample constitutes: 1 Oil Can
A brief description of the sample: 3/4" HMA-SP Oil
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Teichert Woodland
Performance Grade: PG 64-10
Modified:
Lot number: 3
Sublot number: 1
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: Pacific Northwest Oil - Stockton CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
