Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994600 DEA: 081N1704 EFIS: 0822000107
QA Service Level: 1
DIST-CO-RTE-PM: 08-SBD-15-R108.0/R115.0
Work Description: RHMA, HIGH DENSITY POLYURETHANE INJECTION & COLD PLANE AC PAVEMENT.
Location Description: SAN BERNARDINO COUNTY NEAR BARSTOW FROM 0.6 MILE NORTH OF CLYDE V. KANE REST AREA TO 0.3 MILE SOUTH OF BIRD DITCH BRIDGE
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: Unknown
Resident Engineer: Thanh Pham Structure Rep.: Unknown
DIME Sample ID: 2024-05-01-47
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Verification
Type of Material: Asphalt Rubber Binder
Sample Taken Date: 05/01/2024
Date that the sample was received by the laboratory/organization performing the testing: 04/25/2024
The quantity of what the sample constitutes: 1can
A brief description of the sample: Asphalt Rubber Binder
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: World Oil
Asphalt modifier supplier:
Performance Grade: PG 64-16
Lot number:
Sublot number:
Asphalt Rubber Binder Mix Number:
