Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 213121 DEA: 09373504 EFIS: 0918000003
QA Service Level: 1
DIST-CO-RTE-PM: 09-MNO-395-93.7/106.3
Work Description: CONSTRUCT HOT MIX ASPHALT OVER COLD IN-PLACE RECYCLED PAVEMENT.
Location Description: MONO COUNTY NEAR WALKER FROM ROUTE 108 TO EASTSIDE LANE
Contractor Name: ROAD AND HIGHWAY BUILDERS OF CALIFORNIA, INC.
Contractor Address: P.O. BOX 70846, Reno, NV 89570
Resident Engineer: Lee Scotese Structure Rep.: Unknown
DIME Sample ID: 2018-07-27-11
TL Number from the TL Form:
Sample Submitted By Organization: CT D09 - Bishop Field Laboratory
Sample Organization Contact: (760) 872-5211
Type of Sample: Quality Assurance
Type of Material: Asphalt Binder
Sample Taken Date: 07/27/2018
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 750 Tons
A brief description of the sample: HMA Binder
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Road and Highway Builders
Performance Grade: PG64-28M
Modified:
Lot number:
Sublot number:
Tank number:
Time of sample:
HMA Supplier:
Certified Asphalt Supplier:
Multigrade:
Multigrade Type:
Asphalt Binder Mix Number:
