Sample Record

DIME Sample ID 2021-03-15-18

Project Information

Project IdentifiersProject ID: 214492
DEA: 033F5404
EFIS: 0313000136
DIST-CO-RTE-PM03-SAC-99,160-4.5/5.7,R44.5
Award Date01/24/2020
Closeout Date07/28/2022
Work DescriptionFURNISH PRECAST PRESTRESSED CONCRETE SLAB & PLACE STRUCTURAL CONCRETE.
Location DescriptionSACRAMENTO COUNTY NEAR GALT ON ROUTE 99 FROM NORTH OF MINGO ROAD TO SOUTH OF ARNO ROAD OVERCROSSING AND IN SACRAMENTO ON ROUTE 160 AT AMERICAN RIVER BRIDGE
QA Service Level1 (Verified on 10/23/2019)

Owner Lab

  • CT D03 - Olivehurst Northern Regional Laboratory

Sample Information

Sample Taken Date03/15/2021 Sample Unique Key18
Date that the sample was received by the laboratory/organization performing the testing03/15/2021 Sample typeVerification
A brief description of the samplePG 64-16 Asphalt Binder The quantity of what the sample constitutesJMF Verification
From where was the sample collectedManufacturer First name of sampler or witnessed bySam Mossallem (WITNESS)
Last name of sampler or witnessed byTeichert Personnel (SAMPLER) Title of sampler
Telephone number of sampler Laboratory sample identificationJMF21-012
Linked DIME Sample ID The fabricator/manufacturer/facility nameTeichert Perkins Batch Plant
Transportation Laboratory (TL) NumberC849136 Inspector Lot Number from the Transportation Laboratory (TL) Form
Structure unique identifier Structure name
Bid ItemNot set

Material Information

Material TypeAsphalt Binder Performance GradePG 64-16
ModifiedNo Lot number
Sublot number Tank number
Time of sample HMA Supplier
Certified Asphalt SupplierValero Marketing & Supply - Benicia CA MultigradeNo
Multigrade TypeNot set Asphalt Binder Mix NumberNot set
HMA TypeNot set HMA Supplier Mix ID NumberNot set

JMF Information

Verification IDJMF3513-2021-47 Date Created04/26/2021
JMF Submittal IDJMF3511-23-2021-59 JMF StatusSubmittal Authorized For Use
Producer Mix IDPN202102-SP Authorized Date09/10/2021

Submitted Tests

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