Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000001 DEA: 010H1704 EFIS: 0117000119
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-101-R48.9/55.1
Work Description: COLD PLANE AC PAVEMENT AND PLACE HMA-A, RHMA-G, AND HFST.
Location Description: MENDOCINO COUNTY NEAR WILLITS FROM 0.6 MILE NORTH OF UPP CREEK BRIDGE TO 0.1 MILE SOUTH OF BIG TRAILS DRIVE
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: Unknown
Resident Engineer: Steve Tisell Structure Rep.: Unknown
DIME Sample ID: 2024-08-19-33
TL Number from the TL Form: 778437
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: 08/19/2024
Date that the sample was received by the laboratory/organization performing the testing: 08/19/2024
The quantity of what the sample constitutes: 1 can binder
A brief description of the sample: 1 can PG 58-22 binder
From where was the sample collected: Source
Laboratory sample identification: 24-169
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Granite Ukiah
Performance Grade: PG 58-22
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:
