Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 995055 DEA: 024H0504 EFIS: 0218000080
QA Service Level: 1
DIST-CO-RTE-PM: 02-SHA-273,299-18.5/18.7,24.1/30.3
Work Description: PLACE RHMA, HMA, MINOR CONCRETE, AND REPLACE AC SURFACING.
Location Description: SHASTA COUNTY IN AND NEAR REDDING ON ROUTE 273 FROM 0.5 MILE NORTH OF SULPHUR CREEK BRIDGE TO 0.2 MILE SOUTH OF TWIN VIEW BOULEVARD AND ON ROUTE 299 FROM 0.2 MILE WEST OF HILLTOP DRIVE TO 0.1 MILE EAST OF HOOTENANNY LANE
Contractor Name: TULLIS, INC.
Contractor Address: 16951 Clear Creek Road, Redding, CA 96001
Resident Engineer: Nathan Alexander Structure Rep.: Nicolas Jimenez
DIME Sample ID: 2024-07-21-20
TL Number from the TL Form: 858502
Sample Submitted By Organization: CT D02 - Redding Northern Regional Laboratory
Sample Organization Contact: (530) 225-3194
Type of Sample: Production Start-Up
Type of Material: Hot Mix Asphalt
Sample Taken Date: 07/21/2024
Date that the sample was received by the laboratory/organization performing the testing: 07/22/2024
The quantity of what the sample constitutes: 16 boxes of 3/4" RHMA-G
A brief description of the sample: 3/4-Inch RHMA-G
From where was the sample collected: Manufacturer
Laboratory sample identification: D79650
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Tullis – Northstate Asphalt (Redding, CA)
