Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212886 DEA: 023H1204
QA Service Level: 1
DIST-CO-RTE-PM: 02-TEH-5-R0.0/R22.4
Work Description: COLD PLANE RAC-O, PLACE RHMA-O, REPLACE AC SURFACING, MBGR
Location Description: TEHAMA COUNTY AT AND NEAR CORNING FROM GLENN COUNTY LINE TO 0.3 MILE NORTH OF BRANCH COYOTE CREEK BRIDGE
Contractor Name: TULLIS INC
Contractor Address: P O BOX 493416, REDDING CA 96049
Resident Engineer: Henry Benner Structure Rep.: Unknown
DIME Sample ID: 2018-04-09-16
TL Number from the TL Form: 852096
Sample Submitted By Organization: CT D02 - Redding Northern Regional Laboratory
Sample Organization Contact: (530) 225-3194
Type of Sample: Verification
Type of Material: Asphalt Binder
Sample Taken Date: 04/09/2018
Date that the sample was received by the laboratory/organization performing the testing: 04/10/2018
The quantity of what the sample constitutes: JMF Verification
A brief description of the sample: PG 64-10
From where was the sample collected: Other
Laboratory sample identification: D77319
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Valero - Benicia, CA
Performance Grade: PG 64-10
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: 2018-04-09-16-1
Test Method: AASHTO T228-09r13: Standard Method of Test for Specific Gravity of Semi-Solid Asphalt Materials (Specific Gravity)
Verified Date: 07/13/2018
Date Tested: 04/17/2018
Submitted By Organization: CT D02 - Redding Northern Regional Laboratory
Organization Address: 1657 Riverside Drive,
Organization City: Redding
Organization State: CA
Organization Zipcode: 96001
Organization Email: ward.jenkins@dot.ca.gov
Organization Phone: 530-225-3194
General Comments for this Test:
Test Result Compliance: not applicable
Additional Comments When Verified:
