Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994857 DEA: 010H6104 EFIS: 0117000241
QA Service Level: 1
DIST-CO-RTE-PM: 01-HUM-36-13.5/R36.1
Work Description: COLD PLANE AND OVERLAY HMA, & REPLACE GUARDRAILS.
Location Description: HUMBOLDT COUNTY AT AND NEAR BRIDGEVILLE FROM 3.4 MILES WEST OF GRIZZLY CREEK BRIDGE TO 0.8 MILE EAST OF SOUTH FORK VAN DUZEN RIVER
Contractor Name: MERCER FRASER COMPANY
Contractor Address: PO Box 1006, Eureka, CA 95502
Resident Engineer: Joaquin Rodriquez Structure Rep.: Shantanu Nalawade
DIME Sample ID: 2024-06-28-47
TL Number from the TL Form: 827383
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: 06/28/2024
Date that the sample was received by the laboratory/organization performing the testing: 07/02/2024
The quantity of what the sample constitutes: 1 can of binder
A brief description of the sample: 1 can of PG-64-16 binder
From where was the sample collected: Source
Laboratory sample identification: 24-109
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Mercer Fraser Plant B
Performance Grade: PG 64-16
Modified: No
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier: Valero Marketing & Supply - Benicia CA
Multigrade: No
Multigrade Type:
Asphalt Binder Mix Number:
