Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212680 DEA: 024F5504 EFIS: 0213000005
QA Service Level: 1
DIST-CO-RTE-PM: 02-SIS-89-20.9 - 21.2
Work Description: BRIDGE REPLACEMENT WITH PRE-CAST I-GIRDER AND RECONSTRUCT HIGHWAY
Location Description: SISKIYOU COUNTY NEAR MCCLOUD FROM 0.2 MILE SOUTH TO 0.2 MILE NORTH OF MUD CREEK BRIDGE
Contractor Name: STEELHEAD CONSTRUCTORS, INC.
Contractor Address: PO Box 997, Palo Cedro, CA 96073
Resident Engineer: Mike Zdenek Structure Rep.: Ryan Duran
DIME Sample ID: 2018-10-02-3
TL Number from the TL Form: T101 C 680695
Sample Submitted By Organization: CT D02 - Redding Northern Regional Laboratory
Sample Organization Contact: (530) 225-3194
Type of Sample: Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 10/02/2018
Date that the sample was received by the laboratory/organization performing the testing: 10/03/2018
The quantity of what the sample constitutes: 2 boxs
A brief description of the sample: 3/4-inch Type A HMA, 15 rap PG 64-28m Valero
From where was the sample collected: Manufacturer
Laboratory sample identification: D77677
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Tullis, Northstate Asphalt, Redding, CA
DIME Test ID: 2018-10-02-3-1
Test Method: AASHTO T209-12: Standard Method of Test for Theoretical Maximum Specific Gravity (Gmm) and Density of Asphalt Mixtures (Maximum Specific Gravity)
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
Data has not been verified.
DIME Test ID: 2018-10-02-3-2
Test Method: AASHTO T308-10: Standard Method of Test for Determining the Asphalt Binder Content of Hot Mix Asphalt (HMA) by the Ignition Method (Method A) (Asphalt Binder Content)
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
Data has not been verified.
