Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995029 DEA: 010K3104 EFIS: 0120000062
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-101-30.8/R33.8
Work Description: Calpella Cable Median Barrier
Location Description: MENDOCINO COUNTY NEAR UKIAH FROM ROUTE 101/20 SEPARATION TO 0.1 MILE SOUTH OF UVA DRIVE/NORTH STATE STREET
Contractor Name: MERCER FRASER COMPANY
Contractor Address: Unknown
Resident Engineer: Daniel Kraft Structure Rep.: Unknown
DIME Sample ID: 2024-07-16-62
TL Number from the TL Form: 802713
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: 07/16/2024
Date that the sample was received by the laboratory/organization performing the testing: 07/19/2024
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: 24-123
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Bodean - Santa Rosa
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:
