Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994895 DEA: 060X2804 EFIS: 0618000049
QA Service Level: 1
DIST-CO-RTE-PM: 06-FRE-5-60.1/66.2
Work Description: COLD PLANE EXISTING PAVEMENT AND RESURFACE WITH HMA AND RHMA.
Location Description: FRESNO COUNTY ABOUT 21 MILES WEST OF MENDOTA FROM SHIELDS AVENUE OVERCROSSING TO MERCED COUNTY LINE
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: Unknown
Resident Engineer: Haidar Haddadin Structure Rep.: Unknown
DIME Sample ID: 2024-06-10-102
TL Number from the TL Form: C056406
Sample Submitted By Organization: CT HQ - Sacramento Asphalt Binder Laboratory
Sample Organization Contact: (916) 227-7302
Type of Sample: Acceptance
Type of Material: Asphaltic Emulsion
Sample Taken Date: 06/10/2024
Date that the sample was received by the laboratory/organization performing the testing: 06/26/2024
The quantity of what the sample constitutes: 1 jar
A brief description of the sample: SS-1h 70/30 TACK COAT
From where was the sample collected: Distributor
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: TALLEY OIL INC
