Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 212784 DEA: 023H1504 EFIS: 0217000064
QA Service Level: 1
DIST-CO-RTE-PM: 02-LAS-299-0.0/4.7
Work Description: AC OVERLAY, REPLACE ASPHALT CONCRETE SURFACING AND GUARDRAIL.
Location Description: LASSEN COUNTY NEAR MCARTHUR FROM SHASTA COUNTY LINE TO 4.0 MILES WEST OF MUCK VALLEY HYDRO ROAD.
Contractor Name: J.F. SHEA CONSTRUCTION, INC.
Contractor Address: 17400 Clearcreek Road, Redding, CA 96001
Resident Engineer: Tofael Anwar Structure Rep.: Unknown
DIME Sample ID: 2018-05-31-20
TL Number from the TL Form: 736683
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: 05/31/2018
Date that the sample was received by the laboratory/organization performing the testing: 05/31/2018
The quantity of what the sample constitutes: JMF Verification
A brief description of the sample: Virgin Asphalt Binder
From where was the sample collected: Manufacturer
Laboratory sample identification: D77434
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Valero - Benicia, CA
Performance Grade: PG 58-34 M
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: 2018-05-31-20-1
Test Method: AASHTO T228-09r13: Standard Method of Test for Specific Gravity of Semi-Solid Asphalt Materials (Specific Gravity)
Verified Date: 01/04/2019
Date Tested: 04/23/2018
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:
