Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994856 DEA: 010H5604 EFIS: 0117000236
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-299-0.0/R5.7
Work Description: PLACE RHMA, REPLACE ASPHALT CONCRETE, AND CONCRETE BARRIER TRANSITION.
Location Description: HUMBOLDT COUNTY IN AND NEAR ARCATA FROM ROUTE 299/101 SEPARATION TO 0.2 MILE EAST OF BLUE LAKE UNDERCROSSING
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 215 I STREET, EUREKA, CA 95501
Resident Engineer: Robin Collins Structure Rep.: Jarred Burrows
DIME Sample ID: 2024-05-29-25
TL Number from the TL Form: 972381
Sample Submitted By Organization: CT D01 - District 1 Materials Laboratory
Sample Organization Contact: (707) 496-0974
Type of Sample: Acceptance
Type of Material: Asphalt Binder
Sample Taken Date: 05/29/2024
Date that the sample was received by the laboratory/organization performing the testing: 05/30/2024
The quantity of what the sample constitutes: 1 can binder
A brief description of the sample: 1 can PG 64-16 binder
From where was the sample collected: Source
Laboratory sample identification: 24-086
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Kernen Blue Lake Plant
Performance Grade: PG 64-16
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: VSS Emutech - Redding CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
