Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000090 DEA: 024J9204 EFIS: 0223000087
QA Service Level: 1
DIST-CO-RTE-PM: 02-TRI-299-61.0/64.0,70.0/72.2
Work Description: ASPHALT RUBBER CHIP SEAL WITH REPLACE ASPHALT CONCRETE SURFACING.
Location Description: TRINITY COUNTY NEAR DOUGLAS CITY FROM STEEL BRIDGE ROAD TO 1.5 MILES WEST OF GRASS VALLEY CREEK BRIDGE NO 05-0013 AND FROM 2.6 MILES EAST OF TRINITY DAM BOULEVARD TO THE SHASTA COUNTY LINE
Contractor Name: AMERICAN PAVEMENT SYSTEMS, INC.
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2024-08-05-49
TL Number from the TL Form: C854552
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: 08/05/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/09/2024
The quantity of what the sample constitutes: 1of1
A brief description of the sample: 1 bottle of emulsion
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Albina - Klamath Falls, OR
