Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212852 DEA: 010H7604
QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-101-33.0/42.0
Work Description: Fire Damage Repairs: Roadway Repair, Drainage/Slope Repair, Erosion Control, Fencing, MBGR and Sign Replacement, Hazard Tree and Debris Removal.
Location Description:
Contractor Name: GRANITE CONSTRUCTION COMPANY
Contractor Address: 1324 S. State Street, Ukiah, CA 95482
Resident Engineer: MUNES NASH Structure Rep.: Unknown
DIME Sample ID: 2018-02-20-28
TL Number from the TL Form: Unknown
Sample Submitted By Organization: CT D01 - District 1 Materials Laboratory
Sample Organization Contact: (707) 496-0974
Type of Sample: Quality Control
Type of Material: Asphalt Binder
Sample Taken Date: 02/20/2018
Date that the sample was received by the laboratory/organization performing the testing: 02/20/2018
The quantity of what the sample constitutes: renewal
A brief description of the sample: pg 64-16
From where was the sample collected: Manufacturer
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: granite ukiah
Performance Grade: PG 64-16
Modified:
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier:
Multigrade:
Multigrade Type:
Asphalt Binder Mix Number:
DIME Test ID: 2018-02-20-28-1
Test Method: AASHTO T228-09r13: Standard Method of Test for Specific Gravity of Semi-Solid Asphalt Materials (Specific Gravity)
Verified Date: 03/30/2018
Date Tested: 03/30/2018
Submitted By Organization: CT D01 - District 1 Materials Laboratory
Organization Address: 1726 Albee Street,
Organization City: Eureka
Organization State: CA
Organization Zipcode: 95501
Organization Email: leif.ayres@dot.ca.gov
Organization Phone: (707) 496-0974
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
