Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994330 DEA: 09366404 EFIS: 0916000006
QA Service Level: 1
DIST-CO-RTE-PM: 09-MNO-395-58.2/60.4
Work Description: HOT MIX ASPHALT (TYPE A), IMPORTED BORROW, AND ROADWAY EXCAVATION.
Location Description: MONO COUNTY ABOUT 6 MILES NORTH OF LEE VINING FROM ROUTE 167 TO 0.4 MILE NORTH OF CONWAY RANCH ROAD
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 500 South Main Street, Bishop, CA 93514
Resident Engineer: David Carruba Structure Rep.: Unknown
DIME Sample ID: 2024-07-01-2
TL Number from the TL Form:
Sample Submitted By Organization: CT D09 - Bishop Field Laboratory
Sample Organization Contact: (760) 872-5211
Type of Sample: Acceptance
Type of Material: Asphalt Binder
Sample Taken Date: 07/01/2024
Date that the sample was received by the laboratory/organization performing the testing: 07/01/2024
The quantity of what the sample constitutes: 2 cans of oil
A brief description of the sample: PG 58-34 M
From where was the sample collected: Source
Laboratory sample identification: Oil-01
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Lee Vining
Performance Grade: PG 58-34 M
Modified: Yes
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier: Granite Lee Vining
Certified Asphalt Supplier: Western Emulsions Incorporated - Mojave CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
