Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212996 DEA: 023H1404
QA Service Level: 1
DIST-CO-RTE-PM: 02-TRI,SHA-36-0.0/R3.5,0.0/4.0
Work Description: AC OVERLAY, REPLACE AC SURFACE, GUARDRAIL, SHOULDER BACKING
Location Description: SHASTA AND TRINITY COUNTIES FROM TRINITY COUNTY LINE TO 0.4 MILE EAST OF HARRISON GULCH ROAD AND FROM HUMBOLDT COUNTY LINE TO 0.2 MILE EAST OF MAD RIVER ROAD
Contractor Name: TULLIS, INC.
Contractor Address: Unknown
Resident Engineer: MANDHIR GREWAL Structure Rep.: Unknown
DIME Sample ID: 2018-05-21-10
TL Number from the TL Form: 002140
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: 05/21/2018
Date that the sample was received by the laboratory/organization performing the testing: 05/22/2018
The quantity of what the sample constitutes: JMF Verification Renewal
A brief description of the sample: PG 64-28 PM
From where was the sample collected: Manufacturer
Laboratory sample identification: D77409
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Valero - Benicia, CA
Performance Grade: PG 64-28 PM
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: 2018-05-21-10-1
Test Method: AASHTO T228-09r13: Standard Method of Test for Specific Gravity of Semi-Solid Asphalt Materials (Specific Gravity)
Verified Date: 09/27/2018
Date Tested: 04/20/2018
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:
Additional Comments When Verified:
